7. Permanent Disability, Temporary Disability etc 3

Question 1

What are the defined regions of the body mentioned in the statute?

Answer 1

One of the defined regions of the body as stated in the statute is ‘A Hearing.’ Other regions are not specified in the provided text but typically include areas like limbs back and other senses.

Question 2

Can previous injuries impact the assessment of permanent disability from a subsequent injury?

Answer 2

Yes when assessing permanent disability from a subsequent industrial injury it is necessary to determine what percentage of the permanent disability was caused directly by the recent injury and what percentage was attributed to other factors including prior industrial injuries.

Question 3

What is the role of the physician in determining the cause of permanent disability?

Answer 3

The physician must assess and determine the approximate percentages of permanent disability caused by the recent industrial injury versus other factors including prior injuries; however if the physician is unable to make this evaluation the conclusion may be affected.

Question 4

What does ‘presumption affecting the burden of proof’ mean?

Answer 4

‘Presumption affecting the burden of proof’ means that if a certain fact is established such as a prior award of permanent disability it shifts the responsibility to prove otherwise onto the opposing party in any subsequent legal proceedings.

Question 5

What does Section 4662 state regarding total character of injury or illness?

Answer 5

Section 4662 states that an injury or illness may be conclusively presumed to be total in character which permits exceptions to the usual 100 percent limit on total accumulated permanent disability awards.

Question 6

What factors should be considered when calculating permanent disability percentages?

Answer 6

Factors to consider include the direct result of the injury arising out of and occurring in the course of employment as well as other contributing factors before and after the industrial injury including prior industrial injuries.

Question 7

What must a physician include in their report when unable to determine the effect of a prior condition on permanent disability?

Answer 7

The physician must state the specific reasons why they could not make a determination regarding the effect of the prior condition on the permanent disability arising from the injury.

Question 8

What must a physician do if they cannot determine the effect of a prior condition on permanent disability?

Answer 8

The physician shall consult with other physicians or refer the employee to another physician from whom the employee is authorized to seek treatment or evaluation.

Question 9

What information must an employee who claims an industrial injury disclose upon request?

Answer 9

The employee must disclose all previous permanent disabilities or physical impairments.

Question 10

What are the categories of physical impairments mentioned in this section?

Answer 10

The categories include: A) Vision B) Mental and behavioral disorders C) The spine D) The upper extremities (including shoulders) E) The lower extremities (including hip joints) F) The head face cardiovascular system respiratory system and all other systems or regions of the body not specifically listed in subparagraphs A to F.

Question 11

Is there any allowance for permanent disabilities not being taken into account as per this section?

Answer 11

Nothing in this section shall be construed to permit the permanent disability related to factors not covered or outlined in the document.

Question 12

What is the maximum combined disability rating that can be assigned for individual injuries sustained from the same industrial accident?

Answer 12

The combined disability rating for individual injuries sustained by an employee from the same industrial accident shall not exceed 100 percent.

Question 13

What should evaluations and medical reports comply with according to the given text?

Answer 13

Evaluations and medical reports must comply with the Administrative Director Evaluation and Reporting Guidelines as per Labor Code sections 4060 4061 4062 4062.1 4062.2 4064 4067 or 5703.5.

Question 14

What must each reporting evaluator include in their comprehensive medical-legal report?

Answer 14

Each reporting evaluator must state the date the examination was completed and the street address where the examination was performed.

Question 15

If an evaluator signs a report on a different date than when the examination was completed what must they do?

Answer 15

The evaluator must enter the date the report is signed next to or near the signature on the report.

Question 16

What are evaluators required to address in their reports?

Answer 16

Evaluators are required to address all contested medical issues arising from all injuries reported during the examination.

Question 17

What does Labor Code section 4060 pertain to?

Answer 17

Labor Code section 4060 pertains to the requirements for medical evaluations in cases of work-related injuries.

Question 18

What does Labor Code section 4061 govern?

Answer 18

Labor Code section 4061 governs the process for determining the level of permanent disability resulting from work-related injuries.

Question 19

What is the purpose of Labor Code section 4062?

Answer 19

Labor Code section 4062 outlines the procedures for the employee to challenge a medical evaluation or report.

Question 20

Explain the significance of Labor Code sections 4062.1 and 4062.2.

Answer 20

Labor Code sections 4062.1 and 4062.2 provide specific guidelines for the evaluation and resolution of disputes regarding the extent of injuries and necessary medical treatments.

Question 21

What is the focus of Labor Code section 4064?

Answer 21

Labor Code section 4064 focuses on the evaluation of permanent disability ratings and the process for re-evaluating previously assigned ratings.

Question 22

Describe the relevance of Labor Code section 4067.

Answer 22

Labor Code section 4067 addresses the issue of rehabilitation benefits for employees who sustain injuries on the job.

Question 23

What does Labor Code section 5703.5 pertain to?

Answer 23

Labor Code section 5703.5 pertains to the reporting and evaluating processes for injuries in specific industries.

Question 24

What is the purpose of claim forms in relation to an employee’s appointment with a medical evaluator?

Answer 24

Claim forms must be submitted prior to the date of the employee’s appointment to ensure that issues addressed are within the evaluator’s scope of practice and clinical competence.

Question 25

What should the reporting evaluator do according to subdivision 35a3?

Answer 25

The reporting evaluator shall attempt to address each question raised by each party in the issue cover letter sent to them.

Question 26

What happens if the evaluator finds that the injured worker is permanent and stationary for the evaluated body part?

Answer 26

The evaluator must complete the Physician's Report of Permanent and Stationary Status and Work Capacity DWC-AD Form 10133.36 and serve it on the claims administrator along with the medical report.

Question 27

What is required of the evaluator regarding disputed medical issues?

Answer 27

The evaluator must at the earliest opportunity and no later than the report's service date inform the parties in writing of any disputed medical issues that fall outside of their scope of practice and clinical competency.

Question 28

What is the DWC-AD Form 10133.36 used for?

Answer 28

The DWC-AD Form 10133.36 is used for documenting the Physician's Report of Permanent and Stationary Status and Work Capacity.

Question 29

How should an evaluator communicate information about disputed medical issues?

Answer 29

The evaluator should communicate any disputed medical issues in writing to the parties involved.

Question 30

Why is it important for claim forms to be issued before the medical evaluator's appointment?

Answer 30

It is important to ensure that the issues being evaluated are relevant and within the evaluator's professional expertise facilitating an accurate and fair assessment.

Question 31

What are the implications if an evaluator does not adhere to notifying parties about disputed medical issues outside their scope?

Answer 31

Failure to notify could result in legal repercussions or complications in the claims process and may affect the injured worker's rights.

Question 32

What does 'permanent and stationary' imply in the context of an injured worker?

Answer 32

'Permanent and stationary' indicates that the employee's medical condition has stabilized and is unlikely to improve further which is critical for determining compensation and benefits.

Question 33

What are the sections of the Labor Code mentioned that pertain to obtaining an additional evaluation?

Answer 33

The sections mentioned are 4062.1 and 4062.2.

Question 34

What must an evaluator do when initiating an additional evaluation in a different specialty?

Answer 34

The evaluator shall send a copy of the written notification.

Question 35

In what situation should the same evaluator be utilized for a new injury or illness claim?

Answer 35

The same evaluator should be utilized if the new injury or illness claimed involves the same type of body part or body system and if the parties involved are the same.

Question 36

What should happen if either party objects to a new medical issue within the evaluator's scope?

Answer 36

If either party objects to any new medical issue within the evaluator's scope of practice and clinical competence the parties should utilize to the extent possible the same evaluator who reported previously.

Question 37

What is the general time frame for an evaluator to be available for deposition after a notice of deposition?

Answer 37

The evaluator must make themselves available for deposition within at least one hundred twenty (120) days of the notice of deposition.

Question 38

Under what circumstances can the availability of the evaluator for deposition be altered?

Answer 38

The availability can be altered if the Appeals Board or a Workers' Compensation Administrative Law Judge orders otherwise or if the parties agree otherwise.

Question 39

Who has the right to request the deposition of the evaluator?

Answer 39

The unrepresented injured worker has the right to request the deposition of the evaluator.

Question 40

What is the location requirement for depositions under Labor Code section 5710?

Answer 40

Depositions shall be held at the location where the evaluation examination was performed or at a facility or office chosen by the deposing party that is no more than 20 miles from the location of the evaluation examination.

Question 41

What is the relevant time frame for evaluations performed on injuries before January 1 2013 related to utilization review decisions?

Answer 41

For injuries that occurred before January 1 2013 the utilization review decision must be communicated to the requesting physician on or before June 30 2013.

Question 42

What must be consistent with the Agreed Medical Evaluator's opinion in a comprehensive medical-legal report?

Answer 42

The evaluator's opinion must be consistent with and apply the standards of evidence-based medicine set out in Division 1 Chapter 4.5 Subchapter 1 sections 9792.20 et seq of Title 8 of the California Code of Regulations Medical Treatment Utilization Schedule.

Question 43

What document outlines the standards of evidence-based medicine for medical evaluations in California workers' compensation cases?

Answer 43

The standards of evidence-based medicine are outlined in Division 1 Chapter 4.5 Subchapter 1 sections 9792.20 et seq of Title 8 of the California Code of Regulations Medical Treatment Utilization Schedule.

Question 44

What should a comprehensive medical-legal report include when providing an opinion on a disputed medical treatment issue?

Answer 44

The comprehensive medical-legal report should include an opinion from an Agreed Medical Evaluator or Qualified Medical Evaluator that is consistent with the standards of evidence-based medicine.

Question 45

What is the significance of the date January 1 2013 in the context of medical evaluations and utilization review?

Answer 45

January 1 2013 marks the cut-off date for injuries that if evaluated allow for related utilization review decisions to be communicated by June 30 2013 for disputes over medical treatment.

Question 46

What role does a Qualified Medical Evaluator play in the context of disputing medical treatment issues?

Answer 46

A Qualified Medical Evaluator provides an opinion in a comprehensive medical-legal report ensuring that the opinion is consistent with established standards of evidence-based medicine.

Question 47

What is the potential limit for the travel distance for depositions linked to evaluations?

Answer 47

The potential travel limit for depositions linked to evaluations is a maximum of 20 miles from the location of the evaluation examination.

Question 48

How does the Labor Code section 5710 affect the deposition process in workers' compensation cases?

Answer 48

Labor Code section 5710 outlines the requirements regarding the location of depositions ensuring they are held conveniently relative to where the medical evaluations occurred.

Question 49

What does the acronym 'AME' stand for in the context of medical evaluations in California?

Answer 49

'AME' stands for Agreed Medical Evaluator a professional who provides medical opinions in disputed cases.

Question 50

What are the guidelines for evaluation when the Medical Treatment Utilization Schedule does not address an injury?

Answer 50

The evaluator's medical opinion must be consistent with and reference other evidence-based medical treatment guidelines peer-reviewed studies and articles if available. Additionally the evaluator must explain the medical basis for their reasoning and conclusions.

Question 51

As of July 1 2013 what is the role of an Agreed Medical Evaluator or Qualified Medical Evaluator concerning disputed medical treatment issues?

Answer 51

They shall not provide an opinion on any disputed medical treatment issue but are required to offer an opinion on whether the injured worker will need future medical care to cure or relieve the effects of an industrial injury.

Question 52

What declaration must be included in the report by each reporting evaluator?

Answer 52

Each reporting evaluator must include a declaration under penalty of perjury stating that they did not discriminate against any parties to the action or the injured worker during the evaluation process or in the content of the report.

Question 53

What should an evaluator do if the Medical Treatment Utilization Schedule does not provide guidance on treating an injury?

Answer 53

The evaluator should refer to other evidence-based medical treatment guidelines peer-reviewed studies and articles while providing a detailed explanation of the medical basis for their conclusions.

Question 54

What is the significance of the declaration made by the evaluator regarding discrimination?

Answer 54

The declaration is important as it ensures that the evaluation process is fair and unbiased affirming that the evaluator conducted their assessment without prejudice against the parties involved.

Question 55

What is meant by 'future medical care' in the context of an evaluation for an injured worker?

Answer 55

Future medical care refers to the medical treatment that the injured worker may require ongoing or in the future to cure or alleviate the effects of an industrial injury.

Question 56

What are the potential consequences if an evaluator does not comply with the requirement for a declaration regarding discrimination?

Answer 56

Non-compliance may lead to legal repercussions invalidate the evaluation and potentially influence the outcome of the worker's compensation claim.

Question 57

What is the importance of referencing peer-reviewed studies in medical evaluations?

Answer 57

Referencing peer-reviewed studies helps to ensure the opinion is grounded in scientifically validated research providing a basis for the treatment recommendations and enhancing credibility.

Question 58

What is the distinction between an Agreed Medical Evaluator and a Qualified Medical Evaluator?

Answer 58

An Agreed Medical Evaluator is typically selected by the parties involved to provide an impartial opinion while a Qualified Medical Evaluator is designated to perform evaluations under specific regulatory frameworks often when there is a dispute over medical treatment.

Question 59

When evaluating an injured worker what is the evaluator required to assess regarding the need for medical care?

Answer 59

The evaluator must assess whether the injured worker will require future medical care to effectively cure or relieve the effects of the industrial injury irrespective of the contested treatment matters.