“(a) This section and section 10133.55 shall only apply to injuries occurring on or after January 1, 2004. (b) When there is a dispute regarding the Supplemental Job Displacement Benefit, the employee, or claims administrator may request the administrative director to resolve the dispute. (c) The party requesting the administrative director to resolve the dispute shall: (1) Complete Form DWC-AD 10133.55 “Request for Dispute Resolution before the Administrative Director;” (2) Clearly state the issue(s) and identify supporting information for each issue and position; (3) Attach all pertinent documents; (4) Submit a copy of the request and all attached documents to the administrative director and serve a copy of the request and all attached documents on all parties; and (5) Attach a signed and dated proof of service to the Form DWC-AD 10133.55 “Request for Dispute Resolution before the Administrative Director.” (d) The opposing party shall have twenty (20) calendar days from the date of the proof of service of the Request to submit the original response and all attached documents to the administrative director and serve a copy of the response and all attached documents on all parties. (e) The administrative director or his or her designee may request additional information from the parties. (f) The administrative director or his or her designee shall issue a written determination and order based solely on the request, response, and any attached documents within thirty (30) calendar days of the date the opposing party's response and supporting information is due. If the administrative director or his or her designee requests additional information, the written determination shall be issued within thirty (30) calendar days from the receipt of the additional information. In the event no decision is issued within sixty (60) calendar days of the date the opposing party’s response is due or within sixty (60) calendar days of the administrative director’s receipt of the requested additional information, whichever is later, the request shall be deemed to be denied. (g) Either party may appeal the determination and order of the administrative director by filing a written petition together with a declaration of readiness to proceed pursuant to section 10250 within twenty calendar days of the issuance of the decision or within twenty days after a request is deemed denied pursuant to subdivision (f). The petition shall set forth the specific factual and/or legal reason(s) for the appeal as set forth in section 10294.5 of title 8 of the California Code of Regulations.”
(Cal. Code Regs., tit. 8, § 10133.54, quoted in full in Dennis, supra, at p. 11.)
“AD Rule 10133.54 is adjudicatory in nature in that it requires the Administrative Director to issue a written determination and order concerning a SJDB dispute. (Cal. Code Regs., tit. 8, § 10133.54(f).) Furthermore, AD Rule 10133.54 limits the period of time for parties to appear before the WCAB. (Cal. Code Regs., tit. 8, § 10133.54(g).)”
(Dennis, supra, at p. 12.)
“AD Rule 10133.54 restricts and usurps the exclusive adjudicatory power of the WCAB because it exceeds the expressed language of sections 4658.5(c) and 4658.7(h).”
(Dennis, supra, at p. 12.)
“Neither statute authorizes the Administrative Director to adjudicate15 SJDB disputes. As discussed above, the power to adjudicate workers’ compensation claims is reserved exclusively to the WCAB. (§§ 5300, 5307;”
(Dennis, supra, fns. 14–15 [dictionary definitions of “administration” and “adjudicate” omitted], at p. 13.)
“Therefore, to the extent that AD Rule 10133.54 restricts the adjudicatory power of the WCAB, it is invalid, as it exceeds the statutory authority granted to the Administrative Director to administer the SJDB program.”
(Dennis, supra, citing Mendoza, supra, 75 Cal.Comp.Cases at pp. 640–641 (Appeals Bd. en banc); Navarro v. City of Montebello (2014) 79 Cal.Comp.Cases 418, 427 (Appeals Bd. en banc), at p. 13.)
“requiring a party to file an appeal within a specified timeframe is not within the Administrative Director’s administrative authority because, as discussed above, this requirement restricts a party from accessing the jurisdiction of the WCAB.”
(Dennis, supra, at p. 15.)
“To the extent that AD Rule 10208.11 is viewed separately from AD Rule 10133.54, it would be invalid for the same reasons discussed herein.”
(Dennis, supra, fn. 13, at p. 12.)
“Our decision here does not address whether there could be an alternative dispute resolution process that is within the Administrative Director’s authority to implement in the context of SJDB disputes. (See AD’s Response, p. 3:20-4:1.) Our holding here is that AD Rule 10133.54, as written, is invalid.”
(Dennis, supra, at p. 16.)
“Nevertheless, both sections 4658.5(c) and 4658.7(h) restrict the Administrative Director to the administration of the SJDB.”
(Dennis, supra, at p. 13.)
“Section 4658.5(c) specifically authorizes the Administrative Director to adopt regulations governing “other matters necessary to the proper administration” of the SJDB. (§ 4658.5(c).) Read in conjunction with section 4658.7(h), which provides that the Administrative Director “shall adopt regulations for the administration” of the SJDB, we conclude that the Legislature did not create a statutory exception here, implied or expressed, to the WCAB’s exclusive adjudicatory powers.”
(Dennis, supra, at p. 13.)
“Specifically, the WCAB’s exclusive jurisdiction to adjudicate SJDB disputes is guided by the statutory limitations set forth in sections 4658.5, 4658.6, and 4658.7. These include limitations on the amount and usage of the voucher, expiration of the voucher, and exceptions to the entitlement of the voucher. (§§ 4658.5, 4658.6, 4658.7.) In other words, while the WCAB maintains exclusive jurisdiction to adjudicate SJDB disputes, this exclusive jurisdiction is subject to affirmative defenses and the statutory limitations as determined by the trier of fact in light of the evidence and applicable circumstances.”
(Dennis, supra, at p. 14.)
“We further observe that an initial determination of SJDB eligibility by the Administrative Director abrogates the WCAB’s exclusive adjudicatory power and is not consistent with the powers granted to the Administrative Director.”
(Dennis, supra, at p. 14.)
“For instance, we observe that the Administrative Director’s initial determination regarding disputed medical bills is distinct from an initial determination regarding SJDB disputes because the former is based on statute (§ 4603.6(f)) and the latter is based on a regulation (Cal. Code Regs., tit. 8, § 10133.54). Thus, while the Administrative Director may properly make an initial determination regarding disputed medical bills, this is not the case with SJDB disputes.”
(Dennis, supra, citing Lab. Code, § 4603.6(f); Cal. Code Regs., tit. 8, § 10133.54, at p. 14.)
“We note that irrespective of the WCJ’s finding that applicant’s appeal from the Administrative Director’s presumed denial of his request for dispute resolution was untimely, the issue of applicant’s entitlement to SJDB is also properly before us because, as the Administrative Director admits in its Response, the Administrative Director’s alternative dispute resolution program is voluntary.”
(Dennis, supra, fn. 18, at p. 17.)
“Effective 2014, AD Rule 10294.5 was renumbered to 10208.11 without any changes. (Cal. Code Regs., tit. 8, § 10208.11.)”
(Dennis, supra, fn. 13, at p. 12.)
Cross-references: § 2.1 (exclusive jurisdiction); § 1.3 (validity of regulations).
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