Duty to Conduct Investigation; Duty of Good Faith. 8 CCR § 10109

What panels did with this rule

Released decisions that named § 10109, with the passage each turned on. A panel decision persuades; it does not bind.

• ADJ20105844 · 2026-03-13 · Riverside District Office8 CCR § 10109

  Determinative passage · p.5Upon return, we encourage the parties to negotiate this issue in good faith. Absent an agreement, and if defendant is seeking a credit from third-party settlement funds, defendant should promptly file a petition for credit. Defendant is reminded that: "A reasonable investigation must attempt to obtain the information needed to determine and timely provide each benefit[.]" (Cal. Code Regs., tit. 8, § 10109 (emphasis added).)

  Defendant is reminded to promptly file a petition for credit if seeking credit from third-party settlement funds.

  Official decision · page 5 →
• ADJ14145123 · 2025-12-29 · Riverside District Office8 CCR § 10109

  Determinative passage · p.6A defendant, however, has an affirmative duty to investigate the need for medical treatment. The UR processes do not abrogate the claims administrator's duty to investigate whether benefits are due. (Cal. Code Regs., tit. 8, § 10109; see also Braewood Convalescent Hospital, supra, at p. 165).

  Cited to emphasize the ongoing duty to investigate and provide benefits.

  Official decision · page 6 →
• ADJ17808664 · 2025-10-22 · Marina del Rey District Office8 CCR § 10109

  Determinative passage · p.2To the extent that defendant argues that it has been substantially prejudiced or irreparably harmed, we find no evidence in the record to the support this. Applicant has presented multiple reports from multiple physicians providing opinions that applicant's injury is industrial. We would remind defendant of AD Rule 10109, which states, in pertinent part:

  Defendant must investigate claim fully and fairly; cannot restrict investigation to objections or defenses only

  Official decision · page 2 →
• ADJ10116539 · 2024-04-29 · Los Angeles District Office8 CCR § 10109

  Determinative passage · p.5Section 10109 of Title 8 of the Code of Regulations requires defendant to conduct a good faith investigation of a claim. Here defendant never denied the claim and provided medical care commencing the following day of the accident. Nothing suggests a failure to investigate the claim

  Requires good faith investigation of claim; defendant provided care and did not deny claim.

  Official decision · page 5 →
• ADJ11060751 · 2023-01-20 · San Jose District Office8 CCR § 10109

  Determinative passage · p.4(a) To comply with the time requirements of the Labor Code and the Administrative Director's regulations, a claims administrator must conduct a reasonable and timely investigation upon receiving notice or knowledge of an injury or claim for a workers' compensation benefit. (b) A reasonable investigation must attempt to obtain the information needed to determine and timely provide each benefit, if any, which may be due the employee. (1) The administrator may not restrict its investigation to preparing objections or defenses to a claim, but must fully and fairly gather the pertinent information, whether that information requires, or excuses benefit payment. The investigation must supply the information needed to provide timely benefits and to document for audit the administrator's basis for its claims decisions.

  The Appeals Board emphasized the duty to investigate and develop the record fully to provide due process and fair adjudication.

  Official decision · page 4 →
• ADJ13508500 · 2021-06-18 · Sacramento District Office8 CCR § 10109

  Determinative passage · p.1Specifically, Workers' Compensation Appeals Board (WCAB) Rule 10109 provides, in relevant part:

  Defendant failed to comply with this duty by not conducting a reasonable and good faith investigation and not clarifying medical report deficiencies.

  Official decision · page 1 →