Important Terms to Know When You Are Treating for Your California Workers’ Compensation Case: What You Need to Know

Treating Physicians, within California Workers’ Compensation Law, are asked to report on a number of items. These items are very important to injured workers. These items can trigger the payment or non-payment of benefits. They can also determine whether the worker can return to work or be denied that opportunity. Those items can affect whether the employee is entitled to continued or future medical care. The Labor Code and Regulations call for the Physician’s opinion on these items which are considered “Medical Determinations.”

What are Medical Determinations?

Per Regulation Section 9785, “Medical Determination” means a “decision made by the primary treating physician regarding any and all medical issues necessary to determine the employee’s eligibility for compensation. Such issues include but are not limited to the scope and extent of an employee’s continuing medical treatment, the decision whether to release the employee from care, the point in time at which the employee has reached permanent and stationary status, and the necessity for future medical treatment.”

What Does “Released From Care” Mean?

Per Regulation Section 9785, “Released from Care” means a “determination by the primary treating physician that the employee’s condition has reached a permanent and stationary status with no need for continuing or future medical treatment.” With respect to an Injured Worker, being “released from care” can stop the payment of total temporary disability benefits. Also, it can stop the injured worker’s treatment.

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What Does “Continuing Medical Treatment” Mean?

Per Regulation Section 9785, “Continuing Medical Treatment” is “treatment which is occurring or presently planned treatment that is reasonably required to cure or relieve the employee from the effects of the injury.”

What Does “Future Medical Treatment” Mean?

Per Regulation Section 9785, “Future Medical Treatment” means “treatment which is anticipated at some time in the future and is reasonably required to cure or relieve the employee from the effects of the injury.” When Physicians indicate that “future medical treatment” is needed, it is more likely that an injured will be eligible to receive an award of future medical care.

What Does “Permanent and Stationary Status” Mean?

Per Regulation 9785, “Permanent and Stationary Status” is the point when “the employee has reached maximal medical improvement, meaning his or her condition is well stabilized, and unlikely to change substantially in the next year with or without medical treatment. Permanent and Stationary Status can cause the cessation of total temporary disability benefits. It can trigger the injured worker’s return to work.”

What Can an Injured Worker Do to Contest “Medical Determinations?”

California Workers’ Compensation Law allows for many avenues to contest the “Medical Determinations” of a Physician. This includes sending an interrogatory to the Physician, deposing the Physician, obtaining another Physician’s opinion, and obtaining an Agreed Medical Evaluation or Qualified Medical Evaluation. There are various Labor Code Sections which address the contesting of a Treating Physician’s opinions including Labor Code Sections 4061, 4062 and 4062.2. The employment of a skilled attorney can assist with respect to contesting these issues. For example, only an injured worker who is represented can employ an Agreed Medical Evaluator to resolve disputes involving “medical determinations.”

Where Can I Get Legal Advice?

If you would like a free consultation regarding workers compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 26 years. Contact us today for more information.

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