What Is 8 CCR §10109: Investigation and Good Faith Duty?

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.

What does 8 CCR 10109 require?

It requires whoever is deciding your claim to investigate it fully and promptly, and to deal with you honestly while doing it.

The rule applies to the claims administrator. That is the insurance company, the self-insured employer, or the third-party administrator in charge of your workers' comp benefits. This rule is part of the Division of Workers' Compensation's audit program. The Administrative Director uses it to check whether an administrator is meeting its legal duties. It does not replace the Labor Code's own deadlines. It sets the standard the administrator must meet on the way to those deadlines: a real, fair, timely investigation, not a search for reasons to say no.

What counts as a reasonable investigation?

A reasonable investigation gathers every fact needed to decide your claim, not just facts that support a denial.

Section 10109(b) spells this out. The administrator cannot limit its investigation to building objections or defenses. It has to fully and fairly gather the facts, whether those facts support or excuse paying a benefit. The investigation also has to supply what is needed to pay benefits on time. It must document, for audit, why the administrator made its decision. The fact that you carry the burden of proof at a hearing does not let the administrator skip this duty. And the investigation cannot stop at the one benefit you asked about. If the facts suggest you might be due a different benefit too, the administrator has to look into that as well.

Does the administrator have to keep investigating after it makes a decision?

Yes. If new information comes in later, section 10109(c) requires a fresh look, and section 10109(d) requires the administrator to write the whole process down.

Say the administrator already decided a benefit, then later learns a fact it did not have before. Section 10109(c) requires it to look into that new fact and ask whether it changes what you are owed. Section 10109(d) adds a paper trail rule. The administrator must write down what it did and what it found. That record goes in your claim file for audit review. A pattern of missing paperwork can be a sign that the investigation duty was not really met.

What does the good faith duty cover?

Section 10109(e) requires every insurer, self-insured employer, and third-party administrator to deal fairly and in good faith with claimants, including lien claimants.

This good faith duty is separate from the investigation steps above, and it covers more ground. It applies no matter which type of entity is handling your claim. It covers how you are treated through the whole claim, not just at the investigation stage. It also protects lien claimants, such as a medical provider still waiting on payment, not just you as the injured worker. A pattern of delay, stonewalling, or unexplained decisions can raise a good faith problem on its own, even without one missed deadline.

How does this duty connect to your other deadlines?

This investigation duty sits underneath several deadlines you may already be tracking, and a missed one can point to an investigation that never happened.

The investigation this rule requires has to move fast enough to meet the Labor Code's own clocks. Labor Code section 5402 gives the administrator 90 days to accept or deny your claim. It owes you up to $10,000 in medical care while it investigates. This card explains that 90-day rule. Labor Code section 4650 gives the administrator 14 days to send your first disability payment once it knows about the injury and the disability. A late payment there gets an automatic 10 percent increase. This card covers that 14-day deadline. A related Title 8 regulation, 8 CCR 9812, makes the administrator send you a written notice, usually with the medical report behind it, each time it decides one of these points. A rushed or one-sided investigation often shows up first as a missing or confusing notice under that rule.

What if you think your claim was not properly investigated?

An unreasonably delayed or refused benefit can carry its own penalty, apart from whether the investigation itself was adequate.

Start by asking the claims administrator, in writing, what it did to investigate your claim and what it found. Keep a copy of that letter and any reply. Say a benefit was unreasonably delayed or refused. Labor Code section 5814 then allows a penalty of up to 25 percent of the amount delayed, or up to $10,000, whichever is less. This card explains that penalty. If your whole claim was denied, not just one benefit, this guide covers your options after a denial, including the deadlines for appealing to the Workers' Compensation Appeals Board.

How does Yazdchi Law help with an investigation or good faith problem?

Yazdchi Law P.C. reviews whether your claim was actually investigated the way this rule requires, from its office in Palmdale. The firm reviews each matter individually before deciding whether to take it on.

Call (661) 273-1780 or use the contact form for a free consultation. Bring every letter the claims administrator has sent you, along with your own notes on what you were asked for and when. If you decide to hire a lawyer, California workers' comp attorneys are paid on contingency. The fee is usually 15 percent to 18 percent of what you recover, and a workers' compensation judge has to approve it under Labor Code section 4906 before any money changes hands. See the attorney cost guide for more detail.