(a)
(1)
Whenever an injured worker is represented by an attorney, the evaluator shall
serve each comprehensive medical-legal evaluation report, follow-up
comprehensive medical-legal evaluation report and supplemental evaluation
report on the injured worker, his or her attorney and on the claims
administrator, or if none the employer, by completing QME Form 122 (AME or QME
Declaration of Service of Medical-Legal Report Form)(See, 8 Cal. Code Regs.
§
122) and attaching QME Form 122 to
the report, unless section
36.5 of
Title 8 of the California
Code of Regulations applies.
(2) If
applicable in a claim involving disputed injury to the psyche, the evaluator
shall comply with the requirements of section
36.5 of
Title 8 of the California
Code of Regulations (Service of Comprehensive Medical-Legal Report in Claims of
Injury to the Psyche)(See, 8 Cal. Code Regs. §§
36.5,
120 and
121).
(b)
(1)
Whenever an injured worker is not represented by an attorney, the Qualified
Medical Evaluator shall serve each comprehensive medical-legal evaluation
report, follow-up evaluation report or supplemental report that addresses only
disputed issues outside of the scope of Labor Code section
4061, by
completing the questions and declaration of service on the QME Form 111 (QME
Findings Summary Form) (See, 8 Cal. Code Regs. §
111), and by serving the report
with the QME Form 111 attached, on the injured worker and the claims
administrator, or if none on the employer, unless section
36.5 of
Title 8 of the California
Code of Regulations applies.
(2) If
applicable in a claim involving disputed injury to the psyche, the evaluator
shall comply with the requirements of section
36.5 of
Title 8 of the California
Code of Regulations (Service of Comprehensive Medical-Legal Report in Claims of
Injury to the Psyche)(See, 8 Cal. Code Regs. §§
36.5,
120 and
121.)
(c)
(1)
Whenever the evaluator is serving a medical-legal evaluation report that
addresses or describes findings and conclusions pertaining to permanent
impairment, permanent disability or apportionment of an unrepresented injured
worker, the evaluator shall serve the following documents:
A. the evaluation report with a separator
sheet, DWC-CA Form 10232.2 (see, 8 Cal. Code Regs. §
10205.14), as required by Title 8,
California Code of Regulations section
10160(d)(4);
B. the completed QME Form 111 (QME Findings
Summary Form) (See, 8 Cal. Code Regs. §
111) with a separator sheet, DWC-CA
Form 10232.2 (see, 8 Cal. Code Regs. §
10205.14), as required by Title 8,
California Code of Regulations section
10160(d)(4);
C. the DWC-AD Form 100 (DEU) (Employee's
Disability Questionnaire)(See, 8 Cal. Code Regs. §§
10160 and
10161) with a separator sheet,
DWC-CA Form 10232.2 (see, 8 Cal. Code Regs. §
10205.14), as required by Title 8,
California Code of Regulations section
10160(d)(4);
D. the DWC-AD Form 101 (DEU) (Request for
Summary Rating Determination of Qualified Medical Evaluator's Report)(See, 8
Cal. Code Regs. §§
10160 and
10161), with a separator sheet,
DWC-CA Form 10232.2 (see, 8 Cal. Code Regs. §
10205.14), as required by Title 8,
California Code of Regulations section
10160(d)(4);
and
E. A document cover sheet,
DWC-CA Form 10232.1 (see, 8 Cal. Code Regs. §
10205.13).
The documents listed above shall be simultaneously served
on the local DEU office, at the same time as serving the report on the claims
administrator, or if none the employer, and on the unrepresented employee
within the time frames specified in section
38 of Title 8 of the California
Code of Regulations, unless section
36.5 of Title 8 of the California
Code of Regulations applies.
(2) If applicable, in cases involving
disputed injury to the psyche, the evaluator shall follow the procedures
described in section
36.5 of
Title 8 of the California
Code of Regulations (Service of Comprehensive Medical-Legal Report in Claims of
Injury to the Psyche)(See, 8 Cal. Code Regs.§§
36.5,
120 and
121).
(d) If an evaluation report is completed for
an unrepresented employee, in which the QME determines that the employee's
condition has not become permanent and stationary as of the date of the
evaluation, the parties shall request any further evaluation from the same QME
if the QME is currently an active QME and available at the time of the request
for the additional evaluation. If the QME is unavailable, a new panel may be
issued to resolve any disputed issue(s). If the evaluator is no longer a QME,
he/she may issue a supplemental report as long as a face-to-face evaluation (as
defined in section
49(b) of
Title 8
of the California Code of Regulations) with the injured worker is not required.
In no event shall a physician who is not a QME or no longer a QME perform a
follow up evaluation on an unrepresented injured worker.
(e) Except as provided in Section
37 concerning a request for factual
correction, after a Qualified Medical Evaluator has served a comprehensive
medical-legal report that finds and describes permanent impairment, permanent
disability or apportionment in the case of an unrepresented injured worker, the
QME shall not issue any supplemental report on any of those issues in response
to a party's request until after the Disability Evaluation Unit has issued an
initial summary rating report, or unless the evaluator is otherwise directed to
issue a supplemental report by the Disability Evaluation Unit, by the
Administrative Director or by a Workers' Compensation Administrative Law Judge.
A party wishing to request a supplemental report pursuant to subdivision
10160(f) of
Title
8 of the California Code of Regulations, based on the party's objection to or
need for clarification of the evaluator's discussion of permanent impairment,
permanent disability or apportionment, may do so only by sending the detailed
request, within the time limits of subdivision
10160(f), directly
to the DEU office where the report was served by the evaluator and not to the
evaluator until after the initial summary rating has been issued.
NOTE: Forms referred to above are available at no charge by
downloading from the web at www.dir.ca.gov/dwc/forms.html
or by requesting at 1-800-794-6900.
Notes
Cal. Code Regs. Tit. 8, §
36
1. New
section filed 8-1-94; operative 8-31-94 (Register 94, No. 31).
2.
Amendment of section heading, section and NOTE filed 4-14-2000; operative
5-14-2000 (Register 2000, No. 15).
3. Amendment of section heading,
section and NOTE filed 1-13-2009; operative 2-17-2009 (Register 2009, No.
3).
4. Amendment of subsection (e) filed 12-31-2012 as an emergency;
operative 1-1-2013 pursuant to Government Code section
11346.1(d)
(Register 2013, No. 1). A Certificate of Compliance must be transmitted to OAL
by 7-1-2013 or emergency language will be repealed by operation of law on the
following day.
5. Amendment of subsection (e) refiled 7-1-2013 as an
emergency; operative 7-1-2013 (Register 2013, No. 27). A Certificate of
Compliance must be transmitted to OAL by 9-30-2013 or emergency language will
be repealed by operation of law on the following day.
6. Certificate
of Compliance as to 7-1-2013 order, including amendment of section, transmitted
to OAL 8-2-2013 and filed 9-16-2013; amendments operative 9-16-2013 pursuant to
Government Code section
11343.4(b)(3)
(Register 2013, No. 38).
Note: Authority cited: Sections
133,
139.2 and
5307.3, Labor
Code. Reference: Sections
4060,
4061,
4062,
4062.1,
4062.2,
4064,
4067,
4600 and
4660-
4664, Labor
Code.
1. New section filed
8-1-94; operative 8-31-94 (Register 94, No. 31).
2. Amendment of
section heading, section and Note filed 4-14-2000; operative 5-14-2000
(Register 2000, No. 15).
3. Amendment of section heading, section
and Note filed 1-13-2009; operative 2-17-2009 (Register 2009, No.
3).
4. Amendment of subsection (e) filed 12-31-2012 as an emergency;
operative 1-1-2013 pursuant to Government Code section
11346.1(d)
(Register 2013, No. 1). A Certificate of Compliance must be transmitted to OAL
by 7-1-2013 or emergency language will be repealed by operation of law on the
following day.
5. Amendment of subsection (e) refiled 7-1-2013 as an
emergency; operative 7-1-2013 (Register 2013, No. 27). A Certificate of
Compliance must be transmitted to OAL by 9-30-2013 or emergency language will
be repealed by operation of law on the following day.
6. Certificate
of Compliance as to 7-1-2013 order, including amendment of section, transmitted
to OAL 8-2-2013 and filed 9-16-2013; amendments operative 9-16-2013 pursuant to
Government Code section
11343.4(b)(3)
(Register 2013, No. 38).