10770.5 verification form or rejection! (California) (Califo

The filing and enforcement of liens (different states refer to these with different terms) to secure payment for services or goods against a workers' compensation award is complex and filled with special rules - this category is for questions and discussion of this special area of work comp law.

Re: 10770.5 verification form or rejection! (California) (Califo

Postby elh919@aol.com on Mon Jul 06, 2009 1:28 pm

Okay, I'll be the ignorant one here. Just when I thought I had it all down to a science for typing my OCR liens (reminding me of my days when typed all my liens on a typewriter, now the only thing that has changed is that it's on a computer) I now have another piece of paper to add to the paperless system. Where do we actually obtain the 10770.5 verification form? Obviously it's not an OCR form since we use the seperator sheet description of Misc - Correspondence - Other. But I can't find the form anywhere on the DWC website. What am I missing?
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Re: 10770.5 verification form or rejection!

Postby davidd on Mon Jul 06, 2009 1:40 pm

It is not a form.

Here is a suggested format to put on your own letterhead or whatever parchment you happen to have at your disposal:

VERIFICATION TO FILING OF LIEN CLAIM




For Lien Claim, select the applicable section:
□ Sixty days have elapsed since the date of acceptance or rejection of liability for the claim, or the time provided for investigation of liability pursuant to Labor Code section 5402(b) has elapsed, whichever is earlier.
□ The time provided for payment of medical treatment bills pursuant to Labor Code section 4603.2 has elapsed.
□ The time provided for payment of medical-legal expenses pursuant to Labor Code section 4622 has elapsed.

I declare under penalty of perjury under the laws of the State of California that one of the time periods set forth in Rule 10770.5(a) has elapsed.
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Re: 10770.5 verification form or rejection!

Postby davidd on Mon Jul 06, 2009 3:35 pm

BTW - 10770.5 requires FACTS IN DETAIL which support one of the three summary statements.

Here is the reg section:

§10770.5. Verification to Filing of Lien Claim or Application by Lien Claimant.


(a) Any lien claim or application for adjudication filed under Labor Code section 4903(b) shall have attached to it a verification under penalty of perjury which shall contain a statement specifying in detail the facts establishing that one of the following has occurred:

(1) Sixty days have elapsed since the date of acceptance or rejection of liability for the claim, or the time provided for investigation of liability pursuant to Labor Code section 5402(b) has elapsed, whichever is earlier.

(2) The time provided for payment of medical treatment bills pursuant to Labor Code section 4603.2 has elapsed.

(3) The time provided for payment of medical-legal expenses pursuant to Labor Code section 4622 has elapsed.

(b) In addition, if an application for adjudication is being filed, the verification under penalty of perjury also shall contain:

(1) A statement specifying in detail the facts establishing that venue in the district office being designated is proper pursuant to Labor Code section 5501.5(a)(1) or Labor Code section 5501.5(a)(2); and

(2) A statement specifying in detail the facts establishing that the filing lien claimant has made a diligent search and has determined that no adjudication case number exists for the same injured worker and same date of injury at any district office. A diligent search shall include contacting the injured worker, contacting the employer or carrier, or inquiring at the district office with appropriate venue pursuant to Labor Code section 5501.5(a)(1) or Labor Code section 5501.5(a)(2).
(c) The verification shall be in the following form:

I declare under penalty of perjury under the laws of the State of California that one of the time periods set forth in Rule 10770.5(a) has elapsed and, if an application for adjudication is being filed, that venue is proper as set forth in Rule 10770.5(b) and that I have made a diligent search and have determined that no adjudication case number exists for the same injured worker and the same date of injury. In determining that no adjudication case number exists for the same injured worker and the same date of injury, I have made a diligent search consisting of the following efforts (specify):


_____________________________________________

_____________________________________________
_____________________________________________

s/s __________________ on __________________

Failure to attach the verification or an incorrect verification may be a basis for sanctions.

Note: Authority cited: Sections 133, 5307, 5309 and 5708, Labor Code. Reference: Sections 4903 and 4903.6, Labor Code.
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Re: 10770.5 verification form or rejection! (California) (Califo

Postby stewshe on Tue Jul 07, 2009 4:45 am

jpod,

You'll appreciate the following link to "Logical Fallacies." I chose one of my favorites, "Post hoc, ergo propter hoc." (After this, therefore because of this.")

http://www.fallacyfiles.org/posthocf.html

This fallacy is very common in w/c claims. For example, "I was lifting and felt back pain, therefore the lifting caused my back pain."

The truth is perhaps it did, or perhaps not!

Many years ago when I was a newbie claims adjuster I had a claim where a nurse claimed back pain after lifting/moving a patient in bed. She denied any prior back pain and had worked for 10-15 years with no prior back claims.

Numerous tests were performed, but no cause for her pain to one side of her low back could be found. Two or three weeks passed and she complained more and more. Eventually she became deathly ill.

Finally, the cause of her problem was found! One of her kidneys had its major blood supply slowly strangulated by a non-malignant tumor! The kidney had "died" inside her and basically was beginning to decompose! Had the condition not been properly diagnosed when it was she probably would have died within a day or two!

The pain she felt upon lifting was not due to a back injury, but the kidney problem which was totally unrelated to her work. The diagnostic testing was owed as med-legal, but the rest of the claim was denied.
James T. Stewart (stewshe@comcast.net)
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Re: 10770.5 verification form or rejection! (California) (Califo

Postby rider001 on Tue Jul 07, 2009 11:07 am

A lien claimant has to wait for the time period to expire before filing a lien? We can no longer file a lien as soon as the service has been denied?
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Re: 10770.5 verification form or rejection!

Postby davidd on Tue Jul 07, 2009 2:54 pm

That has been the regulation since 11/08.
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Re: 10770.5 verification form or rejection! (California) (Califo

Postby stevehauser on Fri Jul 09, 2010 10:25 am

Note: This only applies to 4903(b) liens. Not all lien claimants.
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Re: 10770.5 verification form or rejection! (California) (Califo

Postby mgmlienservice on Sat Jul 10, 2010 8:45 pm

Here’s a funny story…..while at a lien conference recently I actually had a San Jose WCJ instruct me to advise my client not to file declaration under 10777.5 or they’d sanction them the next time they came across the statement!!

It's actually the other way around, if lien claimants do not file the declaration it’s sanctionable.

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