DEPARTMENT OF INDUSTRIAL RELATIONS WORKERS' COMPENSATION ETHICS ADVISORY COMMITTEE Complaint About a Workers' Compensation Administrative Law Judge (Labor Code §123.6 and Title 8, Cal. Code Regs. §9722.1) Date:__________________________ Your Your name:__________________________________________ telephone number:___________________ Your address:___________________________________________________________________________ Your attorney's Your attorney's name (if any):___________________________ phone number:______________________ Judge's name:________________________________________ WCAB Case No.:____________________ Name of the WCAB case:_________________________________________________________________ In the space below, please specify exactly what action or behavior of the judge you believe is an ethical violation. Please provide relevant dates and the names of others present. Use additional sheets if needed. ____________________________________________________________________________________________________________ It may be a felony to make or cause to be made any knowingly false or fraudulent material statements in support of, or in opposition to, any claim for workers' compensation benefits. Your signature below indicates that you have read and understood the above statement. Date: _____________________ Return to: Signature: ___________________________________________________ Department of Industrial Relations Workers' Compensation Ethics Advisory Committee P.O. Box 420603 San Francisco, CA 94142-0603 Note: Filing a complaint with the Ethics Advisory Committee is NOT a Petition for Reconsideration or Appeal of an Award or Order. Filing a complaint will NOT result in a reversal or change in any decision already made by the judge. American LegalNet, Inc. www.FormsWorkflow.com Judges and Judicial Ethics All Workers' Compensation Administrative Law Judges must follow the California Code of Judicial Ethics. A copy of the Code is available for inspection at any Workers' Compensation Appeals Board office. A copy of the Code may be obtained for the cost or reproduction ($2.00) by writing to: Division of Workers' Compensation P.O. Box 420603 San Francisco, CA 94142-0603 Please make your $2.00 check or money order payable to "Division of Workers' Compensation." If you have evidence that a Worker's Compensation Administrative Law Judge has violated the Code of Judicial Ethics, you may complain either to: The Presiding Workers' Compensation Judge at the Workers' Compensation Board district office where the judge is employed; or to: Workers' Compensation Ethics Advisory Committee Department of Industrial Relations P.O. Box 420603 San Francisco, CA 94142-0603 The Workers' Compensation Ethics Advisory Committee is an independent state committee. The Committee receives and monitors complaints against Workers' Compensation Administrative Law Judges. Complaints must be in writing and must allege specific conduct which violates the Code. Please use the complaint form which is available free at every Appeals Board office. Examples of Code violations are abusive conduct (e.g. threats, harassment, profanity), expressions of bias or prejudice, accepting a payment or gift from a litigant, intoxication, etc. A ruling by a judge - no matter how wrong that ruling is - is not by itself an ethical violation. If you think the Judge made a wrong decision in your case, you should consult with a lawyer or an Information & Assistance Officer. You may have the right to file a petition for reconsideration or to seek some other legal remedy to correct the wrong ruling. You should act promptly. One normally has only 20 days to appeal any decision of a Workers' Compensation Judge. Note: Filing a complaint with the Ethics Advisory Committee is NOT a Petition for Reconsideration or Appeal of an Award or Order. Filing a complaint will NOT result in a reversal or change in any decision already made by the judge. American LegalNet, Inc. www.FormsWorkflow.com If you have a complaint against An Attorney Complaints against attorneys -- either your own or your opponent's -- may be addressed to: The State Bar of California 180 Howard Street San Francisco, CA 94105-1617 1-800-843-9053 (toll free in California) 213-765-1200 (from outside California) An Insurance Company Department of Insurance or DWC Audit Unit Department of Insurance Claims Service 300 So. Spring Street Los Angeles, CA 90013 (800) 927-4357 (213) 987-8921 Division of Workers' Compensation Audit Unit 2424 Arden Way, Suite 305 Sacramento, CA 95825-2403 (916) 263-2710 A Physician Medical Board of California or Industrial Medical Council Department of Consumer Affairs Medical Board of California 1426 Howe Avenue Sacramento, CA 95825 (800) 633-2322 (Toll Free Complaint Line) If your complaint concerns a Qualified Medical Evaluator (QME): Division of Workers' Compensation Medical Unit P. O. Box 420603 So. San Francisco, CA 94142-0603 (510) 286-3700 Any Personnel of the Division of Workers' Compensation except a judge Administrative Director Division of Workers' Compensation P.O. Box 420603 San Francisco, CA 94142-0603 American LegalNet, Inc. www.FormsWorkflow.com