When they must send it
• First: Within 14 days after the claims administrator's date of knowledge of the death, the identity and address of the affected dependent, and the nature of the benefit claimed or which might be due. • Subsequent: On or before the determination date on the previous delay notice.
The deadline this notice puts on you
This notice does not itself start a clock against you.
Rule text
8 CCR § 9812 · 14 unspecified
Trigger: after the claims administrator's date of knowledge both of the death and of the identity and address of the dependent
Notice is required within 14 days after the claims administrator's date of knowledge both of the death and of the identity and address of the dependent
Quoted from the statute, marked computed. The deadline table is a draft extraction — read the official code if the two disagree.
The rule behind it
8 CCR §9812(f)(3)
The official model notice
BENEFIT NOTICE INSTRUCTION MANUAL Claims Administrator Name Address City_State_Zip Telephone Number [include if available] Website address Date [Option] SENT VIA E-MAIL TO employee’s e- mail address Employee Employer: Address Date of Injury: City_State_Zip Claim Number: NOTICE REGARDING DELAY OF WORKERS’ COMPENSATION DEPENDENCY BENEFITS CLAIMS ADMINISTRATOR NAME is handling your workers' compensation claim on behalf of EMPLOYER NAME. This notice is to advise of the status of dependency benefit payments for the workers' compensation injury on the date shown above. A copy of this notice will be sent to all dependents. [Select one of the following:] (1) I am not able to determine whether benefits are due at this time because EXPLANATION OF REASON FOR DELAY. In order to make a decision, I need EXPLANATION OF INFORMATION NEEDED PRIOR TO DECISION. I will contact you once the information has been received or by DATE. (2) Prior to the death of EMPLOYEE NAME, TYPE OF BENEFIT benefits had accrued, but were not paid. …
Published by the Division of Workers’ Compensation in the Benefit Notice Instruction Manual. Excerpt — read the full manual at the source. p.80.
Source · dir.ca.gov →When this went wrong
Decisions of the Workers’ Compensation Appeals Board on this subject. Each quotes the passage it turned on and links to the official PDF.
- ADJ16925192 · 2024-05-10 · Van Nuys District OfficeDeath benefitsapplicant prevailed
Determinative passage · p.6conclude that the applicant was legally liable for her support at the time of injury causing death
The evidence established that Martin the applicant was legally liable for the support of Melanie the applicant at the time of injury, satisfying the conclusive presumption of total dependency under Labor Code section 3501(a).
Official decision · page 6 → - ADJ11808374 · 2023-09-14 · Pomona District OfficeDeath benefitsapplicant prevailed
Determinative passage · p.10Los Angeles, California by Custom Fresh Cuts, whose workers' compensation carrier at the time of injury was The Hartford, sustained injury arising out of and occurring in the course of employment to his digestive and body systems due to gunshots to his abdomen, resulting in his death. 2. The employer had knowledge of the injury to trigger the provision of the notice of potential eligibility to the decedent's dependents, which notice was not provided, thereby tolling the Statute of Limitations and making the claim timely. 3. The claim is not barred by the going and coming rule. 4. The issue of dependency benefits is deferred pending further proceedings and determination by the WCJ, jurisdiction reserved.
The Appeals Board found a strong and reasonable inference that the shooting was connected to the applicant's employment, and that the special risk exception to the going and coming rule applied, making the death compensable.
Official decision · page 10 → - ADJ16635028 · 2026-06-26 · Long Beach District OfficePenalties under Labor Code §5814defendant prevailed
Determinative passage · p.7Whether Sanctions Should be Imposed Against Lien Claimant and/or their Representative [t]he regulations mandate that lien claimants appear at all lien conferences, either in person or by attorney or non-attorney representative.1 The failure to appear at a hearing is sanctionable conduct.2 Sanctions are appropriate for failures to appear where a reasonable excuse is not offered or the offending party has demonstrated a pattern of such conduct.3 (Emphasis added.)
The tribunal found that Paperwork & More had notice of the hearing and failed to offer a reasonable excuse for non-appearance; sanctions were appropriate and imposed jointly and severally on Paperwork & More and Stanley B. Johnson, but not on Premier Psychological Services.
Official decision · page 7 → - ADJ118647 · 2026-06-08 · San Diego District OfficePenalties under Labor Code §5814defendant prevailed
Determinative passage · p.10Applicant did not meet her burden of showing that she should be awarded a penalty on late mileage for treatment for her neck and bilateral shoulders. She did not identify any particular mileage reimbursement request that was late. She did not indicate when they were sent to Defendant or when she received payment. Teri Thompson, program coordinator for the City of San Diego and current adjuster for Applicant's claim, credibly testified that she had issues with Applicant's mileage reimbursement requests. The issues varied but sometimes the requests were not legible, or had dates of service that were cut off, or were requesting mileage for treatment for body parts that were not industrial body parts, or were requesting mileage where the location where treatment occurred was not clear. When problems with mileage requests were noted, applicant would receive in writing why there was a problem with her mileage requests (May 22, 2025 Summary of Evidence, page 2, lines 10-22). For the reasons stated above, applicant did not meet her burden of showing that she should be awarded a penalty for late mileage reimbursement.
Applicant failed to identify any specific late mileage reimbursement request or prove entitlement to a penalty for late reimbursement.
Official decision · page 10 →