Where this sits
- Chapter 4.5.
- Division of Workers' Compensation
- Subchapter 2. Workers' Compensation Appeals Board--Rules and Practice Procedure
- Article 13. Hearings
The regulation, as printed
(a) Within 60 days of service of a medical-legal provider objection to a denial of all or a portion of the medical-legal provider's billing pursuant to Labor Code section 4622(c), the defendant shall file and serve a petition for determination of medical-legal expenses and a Declaration of Readiness to Proceed. Upon filing of a Declaration of Readiness to Proceed, the medical-legal provider shall be added to the official address record. (b) If a defendant has failed to file and serve a petition for determination of medical-legal expenses and a Declaration of Readiness in compliance with subdivision (a), a medical-legal provider may file and serve a petition for reimbursement of medical-legal expenses and a Declaration of Readiness to Proceed. Upon filing of a petition for reimbursement of medical-legal expenses and a Declaration of Readiness to Proceed, the medical-legal provider shall be added to the official address record. (c) Upon receipt of a Declaration of Readiness in accordance with the provisions of subdivisions (a) and (b) of this rule, the matter shall be set for either a status conference or a mandatory settlement conference, in the discretion of the workers' compensation judge. (d) Notwithstanding any other provision of this rule, if there is a threshold issue relating to the case in chief that would entirely defeat the medical-legal expense claim that must be determined prior to adjudicating the medical-legal expense claim dispute, the Workers' Compensation Appeals Board may defer hearing and determining the medical-legal expense claim dispute until the underlying claim of the employee or dependent has been resolved or abandoned. (e) A defendant shall be deemed to have waived all objections to a medical-legal provider's billing, other than compliance with Labor Code sections 4620 and 4621, if: (1) The provider submitted a properly documented billing to the defendant and, within 60 days thereafter, the defendant failed to serve an explanation of review (EOR) that complies with Labor Code section 4603.3 and any applicable regulations adopted by the Administrative Director; or (2) The defendant failed to make payment consistent with an explanation of review (EOR) that complies with Labor Code section 4603.3 and any applicable regulations adopted by the Administrative Director; or (3) The provider submitted a timely and proper request for a second review to the defendant and, within 14 days thereafter, the defendant failed to serve a final written determination that complies with any applicable regulations adopted by the Administrative Director; or (4) The defendant failed to make payment consistent with a final written determination that complies with any applicable regulations adopted by the Administrative Director. (f) A defendant shall be deemed to have waived any objections to a medical-legal provider's billing, other than the amount payable pursuant to the fee schedule(s) in effect on the date the services were rendered and compliance with Labor Code sections 4620 and 4621, if the provider submitted a timely objection to the defendant's EOR regarding a dispute other than the amount payable and the defendant failed to file and serve a petition for determination of medical-legal expenses and a Declaration of Readiness as required by Labor Code section 4622 and subdivision (a) of this rule. (g) A medical-legal provider's bill will be deemed satisfied, and neither the employee nor the employer shall be liable for any further payment, if the defendant issued a timely and proper EOR and made payment consistent with that EOR within 60 days after receipt of the provider's written billing and report and the provider failed to make a timely and proper request for second review in the form prescribed by the Rules of the Administrative Director within 90 days after service of the EOR. (h) A medical-legal provider will be deemed to have waived any objection based on the amount payable under the fee schedule(s) in effect on the date the services were rendered if, within 14 days after receipt of the provider's request for second review, the defendant issued a timely and proper final written determination and made payment consistent with that determination and the provider failed to request IBR within 30 days after service of this second review determination. (i) Bad Faith Actions or Tactics: (1) If the Workers' Compensation Appeals Board determines that, as a result of bad faith actions or tactics, a defendant failed to comply with the requirements, timelines and procedures set forth in Labor Code sections 4622, 4603.3 and 4603.6 and the related Rules of the Administrative Director, the defendant shall be liable for the medical-legal provider's reasonable attorney's fees and costs and for sanctions under Labor Code section 5813 and rule 10421. The amount of the attorney's fees, costs and sanctions payable shall be determined by the Workers' Compensation Appeals Board; however, for bad faith actions or tactics occurring on or after October 23, 2013, the monetary sanctions shall not be less than $500.00. These attorney's fees, costs and monetary sanctions shall be in addition to any penalties and interest that may be payable under Labor Code section 4622 or other applicable provisions of law, and in addition to any lien filing fee, lien activation fee or IBR fee that, by statute, the defendant might be obligated to reimburse to the medical-legal provider. (2) If the Workers' Compensation Appeals Board determines that, as a result of bad faith actions or tactics, a medical-legal provider has improperly asserted that a defendant failed to comply with the requirements, timelines and procedures set forth in Labor Code sections 4622 and 4603.6 and the related Rules of the Administrative Director, the medical-legal provider shall be liable for the defendant's reasonable attorney's fees and costs and for sanctions under Labor Code section 5813 and rule 10421. The amount of the attorney's fees, costs and sanctions payable shall be determined by the Workers' Compensation Appeals Board; however, for bad faith actions or tactics occurring on or after October 23, 2013, the monetary sanctions shall not be less than $500.00.
The statute above this rule
Every regulation names the Labor Code it was written under. This is where the two halves of the law meet.
ImplementsLabor Code § 4603.3Labor Code § 4603.6Labor Code § 4622
Authority and history
Note: Authority cited: Sections 133, 4622, 4627 and 5307, Labor Code. Reference: Sections 4603.3, 4603.6, 4622 and 5813, Labor Code.
1. New section filed 12-17-2019; operative 1-1-2020. Submitted to OAL for printing only pursuant to Government Code section 11351 (Register 2019, No. 51).
What panels did with this rule
Released decisions that named § 10786, with the passage each turned on. A panel decision persuades; it does not bind.
- ADJ8710590 · 2026-05-26 · Riverside District Office8 CCR § 10786
Determinative passage · p.9A defendant has 60 days to review and analyze a medical-legal bill or invoice. (Lab. Code, § 4622(a)(1).) A defendant has two options within this 60-day window: It may pay the bill or invoice in full or pay less than the full amount. Should a defendant decide to pay less than the full amount within the 60-day window, it may still avoid the imposition of a penalty and interest by including an explanation of review (EOR) with its payment. Section 4622 requires that a defendant object to the invoice or billing with an EOR as described in section 4603.3. (Lab. Code, § 4622(a)(1), (e)(1); 4603.3.) Objecting to an invoice with an EOR within the 60-day window is defendant's burden. If a defendant does not pay a proper medical-legal invoice in full or fails to provide an EOR within the 60-day window, then a defendant has waived all objections, other than compliance with sections 4620 and 4621, to the medical-legal provider's billing. (Cal. Code Regs., tit. 8, § 10786(e); see Colamonico, supra.) A defendant is then liable for the reasonable value of the medical-legal services as well as a 10 percent penalty and 7 percent per annum interest.
Defendant failed to comply with timely Explanation of Review requirements, resulting in waiver of objections and entitlement to penalties and interest for cost petitioner.
Official decision · page 9 → - ADJ18961023 · 2026-01-23 · Van Nuys District Office8 CCR § 10786
Determinative passage · p.5WCAB Rule 10786 (Cal. Code Regs., tit. 8, § 10786) sets forth the framework for a
The WCAB considered this rule in evaluating the cost petitioner's claims for sanctions.
Official decision · page 5 → - ADJ10914834 · 2025-08-29 · Anaheim District Office8 CCR § 10786
Determinative passage · p.7Turning to the issue of sanctions, the Appeals Board is authorized to impose sanctions, costs, and attorney's fees under section 5813, which states, in pertinent part, that
Sanctions disallowed as defendant did not engage in bad faith actions or tactics.
Official decision · page 7 → - ADJ18677760 · 2025-08-18 · Santa Ana District Office8 CCR § 10786
Determinative passage · p.13All medical-legal expenses for which the employer is liable shall, upon receipt by the employer of all reports and documents, be paid to whom the funds and expenses are due within 60 days after receipt by the employer of each separate, written billing and report. If payment is not made within this period, that portion of the billed sum then unreasonably unpaid shall be increased by 10 percent, together with interest thereon at the rate of 7 percent per annum retroactive to the date of receipt of the bill and report by the employer.
Applied to determine reasonableness of charges and penalties for late payment.
Official decision · page 13 → - ADJ3739681 · 2025-06-06 · Pomona District Office8 CCR § 10786
Determinative passage · p.6The defendant is deemed to have waived all objections to a medical-legal provider's billing other than compliance with sections 4620 and 4621 if they either fail to serve a timely and compliant explanation of review within 60 days, fail to make payment consistent with the EOR, fail to serve a final written determination after a timely request for second review, or fail to make payment consistent with a final determination. (Cal. Code Regs., tit. 8, § 10786; see Colamonico, supra.) Defendant is then liable for the reasonable value of the medical-legal services, as well as a 10 percent penalty and 7 percent per annum interest. (Lab. Code, § 4622(a)(1)).
The Board noted that the defendant's failure to properly object within 60 days results in liability for the reasonable value of the services plus penalties and interest.
Official decision · page 6 → - ADJ6776516 · 2025-04-01 · Oxnard District Office8 CCR § 10786
Determinative passage · p.5Here however, the issue is whether lien claimant is entitled to a penalty. Lien claimant filed a lien for payment for medical treatment, and subsequently, the WCJ awarded payment in his decision of April 17, 2019. Section 5814 penalties belong to applicant, and we do not consider the issue of whether applicant is entitled to penalties, except to note that section 5814 penalties are not awarded to a lien claimant. Instead, the WCJ must consider whether lien claimant is entitled to a payment of penalties pursuant to section 4622. With respect to any allegation regarding sanctions, we refer the parties to WCAB Rule 10786 (Cal. Code Regs., tit. 8, § 10786.)
Regarding allegations of sanctions, parties are referred to WCAB Rule 10786.
Official decision · page 5 → - ADJ11166186 · 2025-02-03 · Pomona District Office8 CCR § 10786
Determinative passage · p.6A defendant has 60 days to review and analyze a medical-legal bill or invoice. (Lab. Code, § 4622(a)(1).) A defendant has two options within this 60-day window: It may pay the bill or invoice in full or pay less than the full amount. Should a defendant decide to pay less than the full amount within the 60-day window, it may still avoid the imposition of a penalty and interest by including an explanation of review (EOR) with its payment. Section 4622 requires that a defendant object to the invoice or billing with an EOR as described in section 4603.3. (Lab. Code, § 4622(a)(1), (e)(1); 4603.3.) Objecting to an invoice with an EOR within the 60-day window is defendant's burden. If a defendant does not pay a proper medical-legal invoice in full or fails to provide an EOR within the 60-day window, then a defendant has waived all objections, other than compliance with sections 4620 and 4621, to the medical-legal provider's billing. (Cal. Code Regs., tit. 8, § 10786(e); see Colamonico, supra.) A defendant is then liable for the reasonable value of the medical-legal services as well as a 10 percent penalty and 7 percent per annum interest.
Applied to find defendant waived objections to medical-legal billing by failing to timely object or provide EOR.
Official decision · page 6 → - ADJ8318732 · 2024-05-17 · Bakersfield District Office8 CCR § 10786
Determinative passage · p.4Cal.Comp.Cases 473, 476 (Appeals Board en banc).) The WCJ's decision must "set[] forth clearly and concisely the reasons for the decision made on each issue, and the evidence relied on," so that "the parties, and the Board if reconsideration is sought, [can] ascertain the basis for the decision[.]... For the opinion on decision to be meaningful, the WCJ must refer with specificity to an adequate and completely developed record." (Id. at p. 476 (citing Evans v. Workmen's Comp. Appeals Bd. (1968) 68 Cal. 2d 753, 755 [33 Cal.Comp.Cases 350]).) Here, the WCJ concluded that there had been a violation of AD Rule 9982, without engaging in the necessary analysis under Labor Code section 4622 and WCAB Rule 10786. Thus, we will defer the issue of the lien so that the WCJ can consider the application of Labor Code sections 4620, 4621, and 4622 and WCAB Rule 10786.
The Appeals Board deferred the lien issue to the WCJ to consider these legal provisions in further proceedings.
Official decision · page 4 →
Rules beside this one
Article 13. Hearings — regulations rarely stand alone, and the answer is often two sections away.