(a) If as the result of an audit, the
Administrative Director determines that compensation is due and unpaid to an
employee, (s)he shall serve on the audit subject, personally or by first class
mail, a Notice of Intention to Issue a Notice of Compensation Due specifying
the amount, reason and period for which compensation is due. If liability for
compensation is clear but the amount cannot be determined from information in
the claim file, the Administrative Director may direct the claims administrator
to gather the necessary additional information.
(b) The audit subject may file an Objection
to the Notice of Intention within 14 days of receipt. The Objection shall state
in detail the reasons the compensation found due is disputed and may include
supporting documentation and legal argument.
(c) The Administrative Director will review
any Objection, and may set the matter for an administrative meeting, which may
be included as part of a post audit conference. The administrative meeting or
the post audit conference may be set on the Administrative Director's own
initiative or at the request of the audit subject. After review, the
Administrative Director shall either dismiss the Notice of Intention to Issue a
Notice of Compensation Due or issue a Notice of Compensation Due.
(d) If no timely Objection is submitted, the
Administration Director may issue a Notice of Compensation Due. A Notice of
Compensation Due which was issued without a timely Objection shall be final
without right of further review unless the Workers' Compensation Appeals Board
agrees to hear an appeal after a late Objection.
(e) A Notice of Compensation Due shall
specify the amount, reason and period for which compensation is due and shall
order payment of the compensation to the employee or dependent. The Notice of
Compensation Due shall be served on the insurer, self-insured employer or
third-party administrator personally or by certified or registered mail, and a
copy shall be sent by first class mail to the affected employee or dependent.
The compensation due must be paid within 15 days of receipt of the Notice of
Compensation Due unless appealed to the Workers Compensation Appeals Board in
accordance with Section
10115 of these Rules and the
applicable rules of the Workers' Compensation Appeals Board.