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.
- ADJ19102087 · 2026-08-25 · Anaheim District OfficeDeath benefitsapplicant prevailed
Determinative passage · p.3This matter involves a claim for death benefits by the widow of an injured worker who sustained a sudden cardiac arrest and died on November 10, 2023 while at the place and during the period of his employment. (F&O, Opinion on Decision, p. 1.) While the QME in this case states that stress from decedent’s employment contributed to the cause of his sudden cardiac arrest and death, there is no claim for psychiatric injury. (See Applications for Adjudication of Claim- Death, April 8, 2024 and April 29, 2024.) “Stress is not a diagnosis, disease, or syndrome. It is a nonspecific set of emotions or physical symptoms that may or may not be associated with a disease or syndrome. Whether or not stress contributes to a disease or syndrome depends on the vulnerability of the individual, the intensity, duration, and meaning of the stress; and the nature and availability of modifying resources.” (American College of Occupational and Environmental Medicine (ACOEM) Practice Guidelines, 2nd Edition at p. 1055.) However, stress may cause a physical injury or a psychiatric injury or both.
The WCJ and Board found substantial medical evidence from QME Dr. Fischer that stress from decedent’s employment contributed to his sudden cardiac arrest and death, meeting the standard that employment need only be a contributing cause of death for compensability under Labor Code and case law. Defendant’s challenges to the medical evidence and applicant’s credibility were rejected.
Official decision · page 3 → - 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 → - ADJ19773230 · 2026-07-28 · Lodi District OfficePenalties under Labor Code §5814applicant prevailed
Determinative passage · p.5We agree with the WCJ that the rejection of liability was unreasonable, and that the penalty was warranted. Defendant makes much of when a defendant’s duty to investigate a claim first arises. Regardless of when such a duty arises generally, in this case applicant testified that his employer told him that the paperwork for his workers’ compensation case had been initiated soon after the injury, and the WCJ found this testimony credible. In fact, this testimony was completely corroborated by the fact that applicant received a denial on July 23, 2004, a little more than two months after his injury. The denial expressly refers to “your workers’ compensation claim” and “your cardiac claim.” The denial states that it was made “after careful review and consideration” and acknowledges applicant’s upcoming cardiac appointment at Stanford. Although the grounds for the denial were that there was no “substantial medical, legal or factual evidence to support a confirmed diagnosis for a heart condition,” applicant’s co-worker’s and supervisor had witnessed applicant’s injury or its immediate after-effects, saw him transported to the emergency room, where he was admitted to the hospital.
Official decision · page 5 →