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California Labor Code Section 4604.5

Legal Research Home > California Laws > Labor Code > California Labor Code Section 4604.5

(a) Upon adoption by the administrative director of a
medical treatment utilization schedule pursuant to Section 5307.27,
the recommended guidelines set forth in the schedule shall be
presumptively correct on the issue of extent and scope of medical
treatment. The presumption is rebuttable and may be controverted by a
preponderance of the scientific medical evidence establishing that a
variance from the guidelines reasonably is required to cure or
relieve the injured worker from the effects of his or her injury. The
presumption created is one affecting the burden of proof.
   (b) The recommended guidelines set forth in the schedule adopted
pursuant to subdivision (a) shall reflect practices that are evidence
and scientifically based, nationally recognized, and peer reviewed.
The guidelines shall be designed to assist providers by offering an
analytical framework for the evaluation and treatment of injured
workers, and shall constitute care in accordance with Section 4600
for all injured workers diagnosed with industrial conditions.
   (c) Three months after the publication date of the updated
American College of Occupational and Environmental Medicine's
Occupational Medicine Practice Guidelines, and continuing until the
effective date of a medical treatment utilization schedule, pursuant
to Section 5307.27, the recommended guidelines set forth in the
American College of Occupational and Environmental Medicine's
Occupational Medicine Practice Guidelines shall be presumptively
correct on the issue of extent and scope of medical treatment,
regardless of date of injury. The presumption is rebuttable and may
be controverted by a preponderance of the evidence establishing that
a variance from the guidelines reasonably is required to cure and
relieve the employee from the effects of his or her injury, in
accordance with Section 4600. The presumption created is one
affecting the burden of proof.
   (d) (1) Notwithstanding the medical treatment utilization schedule
or the guidelines set forth in the American College of Occupational
and Environmental Medicine's Occupational Medicine Practice
Guidelines, for injuries occurring on and after January 1, 2004, an
employee shall be entitled to no more than 24 chiropractic, 24
occupational therapy, and 24 physical therapy visits per industrial
injury.
   (2) Paragraph (1) shall not apply when an employer authorizes, in
writing, additional visits to a health care practitioner for physical
medicine services.
   (3) Paragraph (1) shall not apply to visits for postsurgical
physical medicine and postsurgical rehabilitation services provided
in compliance with a postsurgical treatment utilization schedule
established by the administrative director pursuant to Section
5307.27.
   (e) For all injuries not covered by the American College of
Occupational and Environmental Medicine's Occupational Medicine
Practice Guidelines or the official utilization schedule after
adoption pursuant to Section 5307.27, authorized treatment shall be
in accordance with other evidence-based medical treatment guidelines
that are recognized generally by the national medical community and
scientifically based.

Last modified: February 13, 2012