California Labor Code § 4060

Determinative passage · p.8Section 4060(b) allows a medical-legal evaluation by the treating physician. Section 4620(a) defines medical-legal expense as “any costs and expenses…for the purpose of proving or disproving a contested claim.” Section 4064(a) provides that the employer is liable for the cost of a comprehensive medical evaluation that is authorized by section 4060. The regulations provide that the “primary treating physician shall render opinions on all medical issues necessary to determine the employee's eligibility for compensation...” (Cal. Code Regs., tit. 8, § 9785(d).) AD Rule 9793(h) states: (h) “Medical-legal expense” means any costs or expenses incurred by or on behalf of any party or parties, the administrative director, or the appeals board for X-rays, laboratory fees, other diagnostic tests, medical reports, medical records, medical

The Appeals Board held that Dr. Haghighinia’s medical-legal report is a compensable medical-legal evaluation and that the lien claimant met the burden to show a contested claim and reasonableness of the expense.

Determinative passage · p.6Defendant avers, however, that lien claimant has not met its burden of establishing compliance with section 4060 as it existed in 2003, governing the admissibility of and liability for medical-legal reporting in workers’ compensation proceedings. The 2003 statute provided, in relevant part:

The Board applied section 4060 to determine the validity of the medical-legal report and lien reimbursement.

Determinative passage · p.5IV. We highlight the following legal principles that may be relevant to our review of this matter: Section 4060(b) allows a medical-legal evaluation by the treating physician. Section 4620(a) defines medical-legal expense as “any costs and expenses … for the purpose of proving or disproving a contested claim.” Section 4064(a) provides that the employer is liable for the cost of a comprehensive medical evaluation that is authorized by section 4060. The regulations provide that the “primary treating physician shall render opinions on all medical issues necessary to determine the employee's eligibility for compensation …” (Cal. Code Regs., tit. 8, § 9785(d).)

These provisions govern the entitlement and timing of medical-legal reports and reimbursement of related expenses.

Determinative passage · p.5Turning now to the merits of the Petition, section 4060 provides guidance as to the QME panel process in cases wherein compensability is disputed and applicant is represented. It provides in relevant part that:

Defendant's QME panel request was premature because it used an incorrect date, violating the timing requirements of these statutes.

Determinative passage · p.8As stated by the WCJ in his Opinion, "[b]ased upon Labor Code 4062.2(b) the earliest the request could have been made was 10/29/25, therefore the request was prematurely made, untimely, not properly served and invalid." (Opinion on Decision, at pp. 1-2.)

Panel 7875837 was stricken as untimely; subsequent requests' validity could not be determined due to inadequate record.

Determinative passage · p.11Accordingly, we concur with the WCJ's determination that the reports of Michael Einbund, M.D., Rosabel Young, M.D., Michael Wells, M.D., and Koruon Daldalyan, M.D., are admissible in proceedings before the WCAB, and may further be submitted for review by the appropriately selected panel QMEs in this matter. We express no opinion as to the evidentiary weight the reports should be accorded, either by the QMEs selected by the parties pursuant to current section 4060 and 4062.2, or by the WCJ.

The panel found that applicant's self-procured reports were obtained prior to the parties' selection of QMEs under current law and were not solely for rebuttal, thus admissible.

Determinative passage · p.8To obtain a QME panel in a represented case, section 4062.2 provides, in relevant part:

The panel request was evaluated for compliance with statutory requirements for QME panel requests under Labor Code section 4060 and 4062.2.

Determinative passage · p.9A medical evaluation is required where there is a dispute over limitations, if any, resulting from an injury, or the existence or extent of permanent impairment. (Lab. Code, § 4060, et seq.) When deciding a medical issue, the WCJ must utilize expert medical opinion. (See Insurance Company of North America v. Workers' Comp. Appeals Bd. (Kemp) (1981) 122 Cal.App.3d 905 [46 Cal.Comp.Cases 913].) The number and nature of the injuries sustained are questions of fact for the WCJ. (Western Growers Ins. Co. v. Workers' Comp. Appeals Bd. (Austin) (1993) 16 Cal.App.4th 227, 234 [58 Cal.Comp.Cases 323].)

The WCJ must base decisions on substantial medical evidence and expert opinion when there is a dispute over permanent disability.