What the panel ordered
Petition for Reconsideration granted; final decision after reconsideration deferred.
Petition for Reconsideration granted and final decision after reconsideration deferred pending further review of merits and entire record.
What was disputed, and how it came out
Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.
The Appeals Board found that the WCJ's conclusion that the request for a medical evaluation and the filing of the claim could not be simultaneous was not based on the clear language of Labor Code section 4060(c).
From the decision · page 4*** [T]he issue in a nutshell is whether a party may request a compensability evaluation when the request is made contemporaneously with the filing of the claim form. Labor Code § 4060 indicates, in relevant part: "If a medical evaluation is required to determine compensability at any time after the filing of the claim form, and the employee is represented by an attorney, a medical evaluation to determine compensability shall be obtained only by the procedure provided in Section 4062.2." (Labor Code § 4060(c))(emphasis added). The court reads this as preluding the simultaneous filing of a claim form and request for a compensability evaluation.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant requested a chiropractic QME panel 16 days after filing the claim form, after the claim was on delay.
Favours Applicant prevailed
This fact supported the finding that the request for compensability evaluation was valid and not simultaneous with the claim filing, contrary to the WCJ's conclusion.
From the decision · page 5Applicant contends that: A careful reading of Labor Code § 4060(c), however, reveals that there is no language, express or implied that states that a claim form must be filed prior to party requesting a compensability evaluation. All that § 4060(c) states is that at any time after the filing of the claim form a medical evaluation is required to determine compensability (as opposed to a request for a medical evaluation), the medical evaluation shall be obtained only by following the procedure set forth in Labor Code section 4062.2. The requesting of the compensability evaluation is not the operative that creates the requirement for a compensability evaluation, it is the status of being denied or delayed that does. In this case, a medical evaluation to determine compensability was indeed required after the filing of the claim, as the claim was on delay after the filing of the claim form and the chiropractic panel to effectuate the compensability evaluation was requested 16 days after the filing of the claim form. Therefore, there was no contravention of either the letter or spirit of Labor Code § 4060(e).
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code
Labor Code section 4060(c)
The Appeals Board interpreted the statute to allow a request for compensability evaluation contemporaneous with the filing of the claim form.
From the decision · page 4*** [T]he issue in a nutshell is whether a party may request a compensability evaluation when the request is made contemporaneously with the filing of the claim form. Labor Code § 4060 indicates, in relevant part: "If a medical evaluation is required to determine compensability at any time after the filing of the claim form, and the employee is represented by an attorney, a medical evaluation to determine compensability shall be obtained only by the procedure provided in Section 4062.2." (Labor Code § 4060(c))(emphasis added). The court reads this as preluding the simultaneous filing of a claim form and request for a compensability evaluation.
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About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
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