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California Labor Code Section 4061

Legal Research Home > California Laws > Labor Code > California Labor Code Section 4061

4061.  This section shall not apply to the employee's dispute of a
utilization review decision under Section 4610, nor to the employee's
dispute of the medical provider network treating physician's
diagnosis or treatment recommendations under Sections 4616.3 and
4616.4.
   (a) Together with the last payment of temporary disability
indemnity, the employer shall, in a form prescribed by the
administrative director pursuant to Section 138.4, provide the
employee one of the following:
   (1) Notice either that no permanent disability indemnity will be
paid because the employer alleges the employee has no permanent
impairment or limitations resulting from the injury or notice of the
amount of permanent disability indemnity determined by the employer
to be payable. If the employer determines permanent disability
indemnity is payable, the employer shall advise the employee of the
amount determined payable and the basis on which the determination
was made, whether there is need for future medical care, and whether
an indemnity payment will be deferred pursuant to paragraph (2) of
subdivision (b) of Section 4650.
   (2) Notice that permanent disability indemnity may be or is
payable, but that the amount cannot be determined because the
employee's medical condition is not yet permanent and stationary. The
notice shall advise the employee that his or her medical condition
will be monitored until it is permanent and stationary, at which time
the necessary evaluation will be performed to determine the
existence and extent of permanent impairment and limitations for the
purpose of rating permanent disability and to determine whether there
will be the need for future medical care, or at which time the
employer will advise the employee of the amount of permanent
disability indemnity the employer has determined to be payable.
   (b) If either the employee or employer objects to a medical
determination made by the treating physician concerning the existence
or extent of permanent impairment and limitations or the need for
future medical care, and the employee is represented by an attorney,
a medical evaluation to determine permanent disability shall be
obtained as provided in Section 4062.2.
   (c) If either the employee or employer objects to a medical
determination made by the treating physician concerning the existence
or extent of permanent impairment and limitations or the need for
future medical care, and if the employee is not represented by an
attorney, the employer shall immediately provide the employee with a
form prescribed by the medical director with which to request
assignment of a panel of three qualified medical evaluators. Either
party may request a comprehensive medical evaluation to determine
permanent disability or the need for future medical care, and the
evaluation shall be obtained only by the procedure provided in
Section 4062.1.
   (d) (1) Within 30 days of receipt of a report from a qualified
medical evaluator who has evaluated an unrepresented employee, the
unrepresented employee or the employer may each request one
supplemental report seeking correction of factual errors in the
report. Any of these requests shall be made in writing. A request
made by the employer shall be provided to the employee, and a request
made by the employee shall be provided to the employer, insurance
carrier, or claims administrator at the time the request is sent to
the evaluator. A request for correction that is made by the employer
shall also inform the employee of the availability of information and
assistance officers to assist him or her in responding to the
request, if necessary.
   (2) The permanent disability rating procedure set forth in
subdivision (e) shall not be invoked by the unrepresented employee or
the employer when a request for correction pursuant to paragraph (1)
is pending.
   (e) The qualified medical evaluator who has evaluated an
unrepresented employee shall serve the comprehensive medical
evaluation and the summary form on the employee, employer, and the
administrative director. The unrepresented employee or the employer
may submit the treating physician's evaluation for the calculation of
a permanent disability rating. Within 20 days of receipt of the
comprehensive medical evaluation, the administrative director shall
calculate the permanent disability rating according to Section 4660
or 4660.1, as applicable, and serve the rating on the employee and
employer.
   (f) Any comprehensive medical evaluation concerning an
unrepresented employee which indicates that part or all of an
employee's permanent impairment or limitations may be subject to
apportionment pursuant to Sections 4663 and 4664 shall first be
submitted by the administrative director to a workers' compensation
judge who may refer the report back to the qualified medical
evaluator for correction or clarification if the judge determines the
proposed apportionment is inconsistent with the law.
   (g) Within 30 days of receipt of the rating, if the employee is
unrepresented, the employee or employer may request that the
administrative director reconsider the recommended rating or obtain
additional information from the treating physician or medical
evaluator to address issues not addressed or not completely addressed
in the original comprehensive medical evaluation or not prepared in
accord with the procedures promulgated under paragraph (2) or (3) of
subdivision (j) of Section 139.2. This request shall be in writing,
shall specify the reasons the rating should be reconsidered, and
shall be served on the other party. If the administrative director
finds the comprehensive medical evaluation is not complete or not in
compliance with the required procedures, the administrative director
shall return the report to the treating physician or qualified
medical evaluator for appropriate action as the administrative
director instructs. Upon receipt of the treating physician's or
qualified medical evaluator's final comprehensive medical evaluation
and summary form, the administrative director shall recalculate the
permanent disability rating according to Section 4660 or 4660.1, as
applicable, and serve the rating, the comprehensive medical
evaluation, and the summary form on the employee and employer.
   (h) (1) If a comprehensive medical evaluation from the treating
physician or an agreed medical evaluator or a qualified medical
evaluator selected from a three-member panel resolves any issue so as
to require an employer to provide compensation, the employer shall
commence the payment of compensation, except as provided pursuant to
paragraph (2) of subdivision (b) of Section 4650, or promptly
commence proceedings before the appeals board to resolve the dispute.
   (2) If the employee and employer agree to a stipulated findings
and award as provided under Section 5702 or to compromise and release
the claim under Chapter 2 (commencing with Section 5000) of Part 3,
or if the employee wishes to commute the award under Chapter 3
(commencing with Section 5100) of Part 3, the appeals board shall
first determine whether the agreement or commutation is in the best
interests of the employee and whether the proper procedures have been
followed in determining the permanent disability rating. The
administrative director shall promulgate a form to notify the
employee, at the time of service of any rating under this section, of
the options specified in this subdivision, the potential advantages
and disadvantages of each option, and the procedure for disputing the
rating.
   (i) No issue relating to a dispute over the existence or extent of
permanent impairment and limitations resulting from the injury may
be the subject of a declaration of readiness to proceed unless there
has first been a medical evaluation by a treating physician and by
either an agreed or qualified medical evaluator. With the exception
of an evaluation or evaluations prepared by the treating physician or
physicians, no evaluation of permanent impairment and limitations
resulting from the injury shall be obtained, except in accordance
with Section 4062.1 or 4062.2. Evaluations obtained in violation of
this prohibition shall not be admissible in any proceeding before the
appeals board.

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Last modified: March 17, 2014