What mitigating factors will DWC consider for penalties?
A. Penalties may be lessened at the DWC administrative director’s discretion based on: the medical consequences or gravity of the violation(s); good faith attempts to comply with the law by the claims administrator or utilization review organization; history of previous penalties; the frequency of violations; and under extraordinary circumstances. (8 CCR ยง 9792.13 (a)) Q. Since the claims administrator (including TPAs) and the URO are held jointly and independently liable for administrative penalties, how should we determine who is responsible for paying the penalties? A. One way would be to clarify this in the contract between the claims administrator and the URO.
