California Labor Code § 4064

Determinative passage · p.7Code, § 4061.) Moreover, under section 4064, a QME is statutorily directed not to address "medical treatment recommendations, which are subject to utilization review as provided by Section 4610, and objections to utilization review determinations, which are subject to independent medical review as provided by Section 4610.5." (Lab. Code, § 4064(a).) We note that petitioner does not appear to be addressing a specific medical treatment issue, but rather the entirety of treatment under the stipulated award. This is not permitted under section 5804.

QME Dr. Graham's reports were excluded as QMEs are statutorily barred from addressing treatment disputes subject to UR and IMR.

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.5On the issue of reimbursement for medical-legal expenses, we note that section 4060(b) allows for medical-legal evaluations by a treating physician and section 4620(a) defines medical- legal expenses as "costs and expenses...for the purpose of proving or disproving a contested claim." AD Rule 9793(h) further defines medical-legal expenses as follows:

Defined medical-legal expenses and employer liability for comprehensive medical evaluations.

Determinative passage · p.7Generally, the Appeals Board is broadly authorized to consider the reports of attending or examining physicians. (Lab. Code, § 5703(a)(1); Valdez v. Workers' Comp. Appeals Bd. (2013) 57 Cal. 4th 1231, 1239 [78 Cal. Comp. Cases 1209] (Valdez).) The weight accorded the evidence, including the weighing of medical-legal reporting in evidence, is a matter to be determined by the WCJ and by the Appeals Board. (Garza v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 312. 317 [35 Cal.Comp.Cases 500]; Lundberg v. Workmen's Comp. Appeals Bd. (1968) 69 Cal.2d 436, 440 [33 Cal.Comp.Cases 656].) Similarly, the Appeals Board is broadly authorized to consider "[r]eports of attending or examining physicians." (§ 5703, subd. (a); Valdez, supra, at p. 1239.) Section 4064(d) provides the no party is prohibited from obtaining any medical evaluation or consultation at the party's own expense, and that all comprehensive medical evaluations obtained by any party shall be admissible in any proceeding before the appeals board except as provided in specified statutes. (Lab. Code, § 4064(d); Valdez, supra, at p. 1239.)

The Board applied these statutes to admit Dr. Haronian's reports and reject defendant's motion to strike.

Determinative passage · p.8The Appeals Board is broadly authorized to consider "[r]eports of attending or examining physicians." (Lab. Code, § 5703(a); Valdez v. Workers' Comp. Appeals Bd. (2013) 57 Cal.4th 1231, 1239 [78 Cal.Comp.Cases 1209].) Section 4064(d) provides that no party is prohibited from obtaining any medical evaluation or consultation at the party's own expense, and that all comprehensive medical evaluations obtained by any party shall be admissible in any proceeding before the appeals board except as provided in specified statutes. (Lab. Code, § 4064(d); Valdez, supra, at p. 1239.) Section 4062.3(a) further provides that any party may provide to the QME, subject to the restrictions set forth in the statute, any records prepared or maintained by the employee's treating physician or physicians and medical and nonmedical records relevant to determination of the medical issue. (Lab. Code, § 4062.3(a).) Moreover, section 4061(i) specifically provides for the admissibility of treating physician reporting in proceedings before the WCAB regarding the existence of extent of permanent impairment. (Lab. Code, § 4061(i).)

Supports admissibility of self-procured medical-legal reports.

Determinative passage · p.2II. In Valdez v. Workers' Comp. Appeals Bd., the California Supreme Court analyzed the admissibility of medical reports in workers' compensation proceedings and opined in pertinent part: [T]he comprehensive medical evaluation process set out in section 4060 et seq. for the purpose of resolving disputes over compensability does not limit the admissibility of medical reports.... Under section 4064, subdivision (d), "no party is prohibited from obtaining any medical evaluation or consultation at the party's own expense," and "[a]ll comprehensive medical evaluations obtained by any party shall be admissible in any proceeding before the appeals board..." except as provided in specified statutes. The Board is, in general, broadly authorized to consider "[r]eports of attending or examining physicians." (§ 5703, subd. (a).)

The Board admitted Dr. Gonzalez's reports and found them substantial evidence.

Determinative passage · p.9II. Section 4060(b) allows for a medical-legal evaluation by a treating physician and 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 an employer is liable for the cost of any comprehensive medical evaluations authorized under 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 testimony, and as needed, interpreter's fees, for the purpose of proving or disproving a contested claim. The cost of medical evaluations, diagnostic tests, and interpreters is not a medical-legal expense unless it is incidental to the production of a comprehensive medical-legal evaluation report, follow-up medical-legal evaluation report, or a supplemental medical-legal evaluation report and all of the following conditions exist:

Employer liable for cost of comprehensive medical evaluations authorized under section 4060.

Determinative passage · p.10II. Section 4060(b) allows for a medical-legal evaluation by a treating physician and 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 an employer is liable for the cost of any comprehensive medical evaluations authorized under 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 testimony, and as needed, interpreter's fees, for the purpose of proving or disproving a contested claim. The cost of medical evaluations, diagnostic tests, and interpreters is not a medical-legal expense unless it is incidental to the production of a comprehensive medical-legal evaluation report, follow-up medical-legal evaluation report, or a supplemental medical-legal evaluation report and all of the following conditions exist:

The Board applied these statutes and regulations to determine that a medical-legal evaluation by a PTP is a medical-legal expense for which the employer is liable if reasonable and necessary.