reglab/housing_qa huggingface dataset:
CA Labor Code § 4604 (2021)
2021 California Code|Labor Code - LAB|DIVISION 4 - WORKERS' COMPENSATION AND INSURANCE|PART 2 - COMPUTATION OF COMPENSATION|CHAPTER 2 - Compensation Schedules|ARTICLE 2 - Medical and Hospital Treatment|Section 4604.

4604.  Controversies between employer and employee arising under this chapter shall be determined by the appeals board, upon the request of either party, except as otherwise provided by Section 4610.5.(Amended by Stats. 2012, Ch. 363, Sec. 40. (SB 863) Effective January 1, 2013.)
CA Labor Code § 4604.5 (2021)
2021 California Code|Labor Code - LAB|DIVISION 4 - WORKERS' COMPENSATION AND INSURANCE|PART 2 - COMPUTATION OF COMPENSATION|CHAPTER 2 - Compensation Schedules|ARTICLE 2 - Medical and Hospital Treatment|Section 4604.5.

4604.5.  (a) The recommended guidelines set forth in the medical treatment utilization schedule adopted by the administrative director pursuant to Section 5307.27 shall be presumptively correct on the issue of extent and scope of medical treatment. The presumption is rebuttable and may be controverted by a preponderance of the scientific medical evidence establishing that a variance from the guidelines reasonably is required to cure or relieve the injured worker from the effects of his or her injury. The presumption created is one affecting the burden of proof.(b) The recommended guidelines set forth in the schedule adopted pursuant to subdivision (a) shall reflect practices that are evidence and scientifically based, nationally recognized, and peer reviewed. The guidelines shall be designed to assist providers by offering an analytical framework for the evaluation and treatment of injured workers, and shall constitute care in accordance with Section 4600 for all injured workers diagnosed with industrial conditions.(c) (1) Notwithstanding the medical treatment utilization schedule, for injuries occurring on and after January 1, 2004, an employee shall be entitled to no more than 24 chiropractic, 24 occupational therapy, and 24 physical therapy visits per industrial injury.(2) (A) Paragraph (1) shall not apply when an employer authorizes, in writing, additional visits to a health care practitioner for physical medicine services. Payment or authorization for treatment beyond the limits set forth in paragraph (1) shall not be deemed a waiver of the limits set forth by paragraph (1) with respect to future requests for authorization.(B) The Legislature finds and declares that the amendments made to subparagraph (A) by the act adding this subparagraph are declaratory of existing law.(3) Paragraph (1) shall not apply to visits for postsurgical physical medicine and postsurgical rehabilitation services provided in compliance with a postsurgical treatment utilization schedule established by the administrative director pursuant to Section 5307.27.(d) For all injuries not covered by the official utilization schedule adopted pursuant to Section 5307.27, authorized treatment shall be in accordance with other evidence-based medical treatment guidelines that are recognized generally by the national medical community and scientifically based.(Amended by Stats. 2012, Ch. 363, Sec. 41. (SB 863) Effective January 1, 2013.)
CA Labor Code § 4605 (2021)
2021 California Code|Labor Code - LAB|DIVISION 4 - WORKERS' COMPENSATION AND INSURANCE|PART 2 - COMPUTATION OF COMPENSATION|CHAPTER 2 - Compensation Schedules|ARTICLE 2 - Medical and Hospital Treatment|Section 4605.

4605.  Nothing contained in this chapter shall limit the right of the employee to provide, at his or her own expense, a consulting physician or any attending physicians whom he or she desires. Any report prepared by consulting or attending physicians pursuant to this section shall not be the sole basis of an award of compensation. A qualified medical evaluator or authorized treating physician shall address any report procured pursuant to this section and shall indicate whether he or she agrees or disagrees with the findings or opinions stated in the report, and shall identify the bases for this opinion.(Amended by Stats. 2012, Ch. 363, Sec. 42. (SB 863) Effective January 1, 2013.)
CA Labor Code § 4606 (2021)
2021 California Code|Labor Code - LAB|DIVISION 4 - WORKERS' COMPENSATION AND INSURANCE|PART 2 - COMPUTATION OF COMPENSATION|CHAPTER 2 - Compensation Schedules|ARTICLE 2 - Medical and Hospital Treatment|Section 4606.

4606.  Any county, city and county, city, school district, or other public corporation within the state which was a self-insured employer under the “Workmen’s Compensation, Insurance and Safety Act,” enacted by Chapter 176 of the Statutes of 1913, may provide such medical, and hospital treatment, including nursing, medicines, medical and surgical supplies, crutches, and apparatus, including artificial members, which is reasonably required to cure or relieve from the effects of an injury to a former employee who was covered under such act, without regard to the 90-day limitation of subdivision (a) of Section 15 of such act for medical treatment. The provisions of this section shall not be operative in any such county, city and county, city, school district, or other public corporation unless adopted by a resolution of the governing body of such public entity.(Added by Stats. 1972, Ch. 451.)
CA Labor Code § 4607 (2021)
2021 California Code|Labor Code - LAB|DIVISION 4 - WORKERS' COMPENSATION AND INSURANCE|PART 2 - COMPUTATION OF COMPENSATION|CHAPTER 2 - Compensation Schedules|ARTICLE 2 - Medical and Hospital Treatment|Section 4607.

4607.  Where a party to a proceeding institutes proceedings to terminate an award made by the appeals board to an applicant for continuing medical treatment and is unsuccessful in such proceedings, the appeals board may determine the amount of attorney’s fees reasonably incurred by the applicant in resisting the proceeding to terminate the medical treatment, and may assess such reasonable attorney’s fees as a cost upon the party instituting the proceedings to terminate the award of the appeals board.(Added by Stats. 1973, Ch. 663.)
CA Labor Code § 4608 (2021)
2021 California Code|Labor Code - LAB|DIVISION 4 - WORKERS' COMPENSATION AND INSURANCE|PART 2 - COMPUTATION OF COMPENSATION|CHAPTER 2 - Compensation Schedules|ARTICLE 2 - Medical and Hospital Treatment|Section 4608.

4608.  No workers’ compensation insurer, self-insured employer, or agent of an insurer or self-insured employer, shall refuse to pay pharmacy benefits solely because the claim form utilized is reproduced by the person providing the pharmacy benefits, provided the reproduced form is an exact copy of that used by the insurer, self-insured employer, or agent.(Added by Stats. 1984, Ch. 137, Sec. 1.)
CA Labor Code § 4610.1 (2021)
2021 California Code|Labor Code - LAB|DIVISION 4 - WORKERS' COMPENSATION AND INSURANCE|PART 2 - COMPUTATION OF COMPENSATION|CHAPTER 2 - Compensation Schedules|ARTICLE 2 - Medical and Hospital Treatment|Section 4610.1.

4610.1.  An employee shall not be entitled to an increase in compensation under Section 5814 for unreasonable delay in the provision of medical treatment for periods of time necessary to complete the utilization review process in compliance with Section 4610. A determination by the appeals board or a final determination of the administrative director pursuant to independent medical review that medical treatment is appropriate shall not be conclusive evidence that medical treatment was unreasonably delayed or denied for purposes of penalties under Section 5814. In no case shall this section preclude an employee from entitlement to an increase in compensation under Section 5814 when an employer has unreasonably delayed or denied medical treatment due to an unreasonable delay in completion of the utilization review process set forth in Section 4610.(Amended by Stats. 2012, Ch. 363, Sec. 44. (SB 863) Effective January 1, 2013.)
CA Labor Code § 4610.3 (2021)
2021 California Code|Labor Code - LAB|DIVISION 4 - WORKERS' COMPENSATION AND INSURANCE|PART 2 - COMPUTATION OF COMPENSATION|CHAPTER 2 - Compensation Schedules|ARTICLE 2 - Medical and Hospital Treatment|Section 4610.3.

4610.3.  (a) Regardless of whether an employer has established a medical provider network pursuant to Section 4616 or entered into a contract with a health care organization pursuant to Section 4600.5, an employer that authorizes medical treatment shall not rescind or modify that authorization after the medical treatment has been provided based on that authorization for any reason, including, but not limited to, the employer’s subsequent determination that the physician who treated the employee was not eligible to treat that injured employee. If the authorized medical treatment consists of a series of treatments or services, the employer may rescind or modify the authorization only for the treatments or services that have not already been provided.(b) This section shall not be construed to expand or alter the benefits available under, or the terms and conditions of, any contract, including, but not limited to, existing medical provider network and health care organization contracts.(c) This section shall not be construed to impact the ability of the employer to transfer treatment of an injured employee into a medical provider network or health care organization. This subdivision is declaratory of existing law.(d) This section shall not be construed to establish that a provider of authorized medical treatment is the physician primarily responsible for managing the injured employee’s care for purposes of rendering opinions on all medical issues necessary to determine eligibility for compensation.(Added by Stats. 2009, Ch. 436, Sec. 1. (AB 361) Effective January 1, 2010.)
CA Labor Code § 4611 (2021)
2021 California Code|Labor Code - LAB|DIVISION 4 - WORKERS' COMPENSATION AND INSURANCE|PART 2 - COMPUTATION OF COMPENSATION|CHAPTER 2 - Compensation Schedules|ARTICLE 2 - Medical and Hospital Treatment|Section 4611.

4611.  (a) When a contracting agent sells, leases, or transfers a health provider’s contract to a payor, the rights and obligations of the provider shall be governed by the underlying contract between the health care provider and the contracting agent.(b) For purposes of this section, the following terms have the following meanings:(1) “Contracting agent” has the meaning set forth in paragraph (2) of subdivision (d) of Section 4609.(2) “Payor” has the meaning set forth in paragraph (3) of subdivision (d) of Section 4609.(Added by renumbering Section 4610 (as added by Stats. 2003, Ch. 203) by Stats. 2004, Ch. 183, Sec. 264. Effective January 1, 2005.)
CA Labor Code § 4614.1 (2021)
2021 California Code|Labor Code - LAB|DIVISION 4 - WORKERS' COMPENSATION AND INSURANCE|PART 2 - COMPUTATION OF COMPENSATION|CHAPTER 2 - Compensation Schedules|ARTICLE 2 - Medical and Hospital Treatment|Section 4614.1.

4614.1.  Notwithstanding subdivision (f) of Section 1345 of the Health and Safety Code, a health care service plan licensed pursuant to the Knox-Keene Health Care Service Plan Act and certified by the administrative director pursuant to Section 4600.5 to provide health care pursuant to Section 4600.3 shall be permitted to accept payment from a self-insured employer, a group of self-insured employers, or the insurer of an employer on a fee-for-service basis for the provision of such health care as long as the health care service plan is not both the health care organization in which the employee is enrolled and the plan through which the employee receives regular health benefits.(Amended by Stats. 1993, Ch. 1242, Sec. 35. Effective January 1, 1994.)
CA Labor Code § 4616.1 (2021)
2021 California Code|Labor Code - LAB|DIVISION 4 - WORKERS' COMPENSATION AND INSURANCE|PART 2 - COMPUTATION OF COMPENSATION|CHAPTER 2 - Compensation Schedules|ARTICLE 2.3 - Medical Provider Networks|Section 4616.1.

4616.1.  (a) An insurer, employer, or entity that provides physician network services that offers a medical provider network under this division and that uses economic profiling shall file with the administrative director a description of any policies and procedures related to economic profiling utilized. The filing shall describe how these policies and procedures are used in utilization review, peer review, incentive and penalty programs, and in provider retention and termination decisions. The insurer, employer, or entity that provides physician network services shall provide a copy of the filing to an individual physician, provider, medical group, or individual practice association.(b) The administrative director shall make each approved medical provider network economic profiling policy filing available to the public upon request. The administrative director may not publicly disclose any information submitted pursuant to this section that is determined by the administrative director to be confidential pursuant to state or federal law.(c) For the purposes of this article, “economic profiling” shall mean any evaluation of a particular physician, provider, medical group, or individual practice association based in whole or in part on the economic costs or utilization of services associated with medical care provided or authorized by the physician, provider, medical group, or individual practice association.(Amended by Stats. 2012, Ch. 363, Sec. 48. (SB 863) Effective January 1, 2013.)
CA Labor Code § 4616.3 (2021)
2021 California Code|Labor Code - LAB|DIVISION 4 - WORKERS' COMPENSATION AND INSURANCE|PART 2 - COMPUTATION OF COMPENSATION|CHAPTER 2 - Compensation Schedules|ARTICLE 2.3 - Medical Provider Networks|Section 4616.3.

4616.3.  (a) If the injured employee notifies the employer of the injury or files a claim for workers’ compensation with the employer, the employer shall arrange an initial medical evaluation and begin treatment as required by Section 4600.(b) The employer shall notify the employee of the existence of the medical provider network established pursuant to this article, the employee’s right to change treating physicians within the network after the first visit, and the method by which the list of participating providers may be accessed by the employee. The employer’s failure to provide notice as required by this subdivision or failure to post the notice as required by Section 3550 shall not be a basis for the employee to treat outside the network unless it is shown that the failure to provide notice resulted in a denial of medical care.(c) If an injured employee disputes either the diagnosis or the treatment prescribed by the treating physician, the employee may seek the opinion of another physician in the medical provider network. If the injured employee disputes the diagnosis or treatment prescribed by the second physician, the employee may seek the opinion of a third physician in the medical provider network.(d) (1) Selection by the injured employee of a treating physician and any subsequent physicians shall be based on the physician’s specialty or recognized expertise in treating the particular injury or condition in question.(2) Treatment by a specialist who is not a member of the medical provider network may be permitted on a case-by-case basis if the medical provider network does not contain a physician who can provide the approved treatment and the treatment is approved by the employer or the insurer.(Amended by Stats. 2012, Ch. 363, Sec. 50. (SB 863) Effective January 1, 2013.)
CA Labor Code § 4616.5 (2021)
2021 California Code|Labor Code - LAB|DIVISION 4 - WORKERS' COMPENSATION AND INSURANCE|PART 2 - COMPUTATION OF COMPENSATION|CHAPTER 2 - Compensation Schedules|ARTICLE 2.3 - Medical Provider Networks|Section 4616.5.

4616.5.  (a) For purposes of this article, “employer” means a self-insured employer, joint powers authority, or the state.(b) For purposes of this article, “entity that provides physician network services” means a medical network licensed by the Department of Insurance or Department of Managed Health Care, or a third-party claims adjusting organization licensed by the Department of Insurance or certified by the Office of Self-Insurance Plans, or a legal entity that offers medical management or physician network services within California.(c) For purposes of this article, “entity that provides ancillary services” means an entity that provides medical services or goods, as authorized by Section 4600, by a nonphysician, including, but not limited to, interpreter services, physical therapy, and pharmaceutical services.(Amended by Stats. 2019, Ch. 647, Sec. 8. (SB 537) Effective January 1, 2020.)
CA Labor Code § 4616.6 (2021)
2021 California Code|Labor Code - LAB|DIVISION 4 - WORKERS' COMPENSATION AND INSURANCE|PART 2 - COMPUTATION OF COMPENSATION|CHAPTER 2 - Compensation Schedules|ARTICLE 2.3 - Medical Provider Networks|Section 4616.6.

4616.6.  No additional examinations shall be ordered by the appeals board and no other reports shall be admissable to resolve any controversy arising out of this article.(Added by Stats. 2004, Ch. 34, Sec. 27. Effective April 19, 2004.)
CA Labor Code § 4616.7 (2021)
2021 California Code|Labor Code - LAB|DIVISION 4 - WORKERS' COMPENSATION AND INSURANCE|PART 2 - COMPUTATION OF COMPENSATION|CHAPTER 2 - Compensation Schedules|ARTICLE 2.3 - Medical Provider Networks|Section 4616.7.

4616.7.  (a) A health care organization certified pursuant to Section 4600.5 shall be deemed approved pursuant to this article if the requirements of this article are met, as determined by the administrative director.(b) A health care service plan, licensed pursuant to Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code, shall be deemed approved for purposes of this article if it has a reasonable number of physicians with competency in occupational medicine, as determined by the administrative director.(c) A group disability insurance policy, as defined in subdivision (b) of Section 106 of the Insurance Code, that covers hospital, surgical, and medical care expenses shall be deemed approved for purposes of this article if it has a reasonable number of physicians with competency in occupational medicine, as determined by the administrative director. For the purposes of this section, a group disability insurance policy shall not include Medicare supplement, vision-only, dental-only, and Champus-supplement insurance. For purposes of this section, a group disability insurance policy shall not include hospital indemnity, accident-only, and specified disease insurance that pays benefits on a fixed benefit, cash-payment-only basis.(d) Any Taft-Hartley health and welfare fund shall be deemed approved for purposes of this article if it has a reasonable number of physicians with competency in occupational medicine, as determined by the administrative director.(Amended by Stats. 2012, Ch. 363, Sec. 51. (SB 863) Effective January 1, 2013.)
CA Labor Code § 4620 (2021)
2021 California Code|Labor Code - LAB|DIVISION 4 - WORKERS' COMPENSATION AND INSURANCE|PART 2 - COMPUTATION OF COMPENSATION|CHAPTER 2 - Compensation Schedules|ARTICLE 2.5 - Medical-Legal Expenses|Section 4620.

4620.  (a) For purposes of this article, a medical-legal expense means any costs and expenses incurred by or on behalf of any party, the administrative director, or the board, which expenses may include X-rays, laboratory fees, other diagnostic tests, medical reports, medical records, medical testimony, and, as needed, interpreter’s fees by a certified interpreter pursuant to Article 8 (commencing with Section 11435.05) of Chapter 4.5 of Part 1 of Division 3 of Title 2 of, or Section 68566 of, the Government Code, for the purpose of proving or disproving a contested claim.(b) A contested claim exists when the employer knows or reasonably should know that the employee is claiming entitlement to any benefit arising out of a claimed industrial injury and one of the following conditions exists:(1) The employer rejects liability for a claimed benefit.(2) The employer fails to accept liability for benefits after the expiration of a reasonable period of time within which to decide if it will contest the claim.(3) The employer fails to respond to a demand for payment of benefits after the expiration of any time period fixed by statute for the payment of indemnity.(c) Costs of medical evaluations, diagnostic tests, and interpreters incidental to the production of a medical report do not constitute medical-legal expenses unless the medical report is capable of proving or disproving a disputed medical fact, the determination of which is essential to an adjudication of the employee’s claim for benefits. In determining whether a report meets the requirements of this subdivision, a judge shall give full consideration to the substance as well as the form of the report, as required by applicable statutes and regulations.(d) If the injured employee cannot effectively communicate with an examining physician because he or she cannot proficiently speak or understand the English language, the injured employee is entitled to the services of a qualified interpreter during the medical examination. Upon request of the injured employee, the employer or insurance carrier shall pay the costs of the interpreter services, as set forth in the fee schedule adopted by the administrative director pursuant to Section 5811. An employer shall not be required to pay for the services of an interpreter who is provisionally certified unless either the employer consents in advance to the selection of the individual who provides the interpreting service or the injured worker requires interpreting service in a language other than the languages designated pursuant to Section 11435.40 of the Government Code.(Amended by Stats. 2012, Ch. 363, Sec. 52. (SB 863) Effective January 1, 2013.)
CA Labor Code § 4621 (2021)
2021 California Code|Labor Code - LAB|DIVISION 4 - WORKERS' COMPENSATION AND INSURANCE|PART 2 - COMPUTATION OF COMPENSATION|CHAPTER 2 - Compensation Schedules|ARTICLE 2.5 - Medical-Legal Expenses|Section 4621.

4621.  (a) In accordance with the rules of practice and procedure of the appeals board, the employee, or the dependents of a deceased employee, shall be reimbursed for his or her medical-legal expenses and reasonably, actually, and necessarily incurred, except as provided in Section 4064. The reasonableness of, and necessity for, incurring these expenses shall be determined with respect to the time when the expenses were actually incurred. Costs for medical evaluations, diagnostic tests, and interpreters’ services incidental to the production of a medical report shall not be incurred earlier than the date of receipt by the employer, the employer’s insurance carrier, or, if represented, the attorney of record, of all reports and documents required by the administrative director incidental to the services. This subdivision is not applicable unless there has been compliance with Section 4620.(b) Except as provided in subdivision (c) and Sections 4061 and 4062, no comprehensive medical-legal evaluations, except those at the request of an employer, shall be performed during the first 60 days after the notice of claim has been filed pursuant to Section 5401, and neither the employer nor the employee shall be liable for any expenses incurred for comprehensive medical-legal evaluations performed within the first 60 days after the notice of claim has been filed pursuant to Section 5401.(c) Comprehensive medical-legal evaluations may be performed at any time after the claim form has been filed pursuant to Section 5401 if the employer has rejected the claim.(d) Where, at the request of the employer, the employer’s insurance carrier, the administrative director, the appeals board, or a referee, the employee submits to examination by a physician, he or she shall be entitled to receive, in addition to all other benefits herein provided, all reasonable expenses of transportation, meals, and lodging incident to reporting for the examination to the same extent and manner as provided for in Section 4600.(Amended by Stats. 1993, Ch. 121, Sec. 43. Effective July 16, 1993.)