reglab/statecodes huggingface dataset:
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 4 - Certification Standards for Health Care Organizations › Section 9779.45 - Minimum Periods of Enrollment

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Pursuant to Labor Code Section
						4600.3:
(a) An employee whose employer does not offer
					 non-occupational health coverage under a plan established pursuant to
					 collective bargaining, and does not offer to pay more than one-half the cost of
					 non-occupational health coverage for that employee under another plan, may be
					 treated for occupational injuries and illnesses by a physician of the
					 employee's choosing after 90 days from the date the injury was
					 reported.
(b) An employee whose
					 employer offers non-occupational health coverage under a plan established
					 pursuant to collective bargaining, or offers to pay more than one-half the cost
					 of non-occupational health coverage for that employee under another plan, may
					 be treated for occupational injuries and illnesses by a physician of the
					 employee's choosing after 180 days from the date the injury was reported or
					 upon the date of contract renewal or open enrollment of the health care
					 organization, whichever occurs first, but in no case until 90 days from the
					 date the injury was reported.
1. New
						section filed 5-17-99; operative 5-17-99 pursuant to Government Code section
						11343.4(d)
						(Register 99, No. 21).
2. Repealer of subsection (c) filed 1-9-2003;
						operative 1-9-2003 pursuant to Government Code section
						11343.4
						(Register 2003, No. 2).
Note: Authority cited: Sections
						  133,
						  4600.3,
						  4600.5,
						  4603.5 and
						  5307.3, Labor
						  Code. Reference: Sections
						  4600,
						  4600.3 and
						  4600.5, Labor
						  Code.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 4 - Certification Standards for Health Care Organizations › Section 9779.5 - Reimbursement of Costs to the Administrative Director; Obligation to Pay Share of Administrative Expense

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Each organization certified under this
					 article shall pay to the administrative director an amount as estimated by the
					 administrative director for the ensuing fiscal year, as a reimbursement of a
					 share of all costs and expenses, including routine on-site surveys, data
					 collection and dissemination and overhead, reasonably incurred in the
					 administration of this article and not otherwise recovered by the
					 administrative director under this article or from the Worker's Compensation
					 Managed Care Fund. The amount shall be assessed annually on or before April 15
					 and may be paid to the Workers' Compensation Managed Care Fund in two equal
					 installments. The first installment shall be paid on or before July 1 of each
					 year and the second installment shall be paid on or before December 15 of each
					 year.
(1) Annual Assessment: The assessment
					 shall be calculated on the basis of the number of enrollees in each individual
					 HCO. Based on the number of enrollees enrolled in the HCO on December 31 of the
					 prior calendar year, the annual assessment shall be $250.00 for 0 to 1000
					 enrollees, $350 for 1001 to 5000 enrollees, and $500 for 5001 or more
					 enrollees.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 4 - Certification Standards for Health Care Organizations › Section 9779.8 - Copies of Documents

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Fees for copies of documents will be charged as set forth
						in Section 9990. Any request for copies of
						documents must include payment of fees by check or money order made payable to
						the Workers' Compensation Managed Care Fund.
1. New
						section filed 2-14-96; operative 2-14-96. Submitted to OAL for printing only
						pursuant to Government Code section
						11351
						(Register 96, No. 7).
Note: Authority: Sections
						  133,
						  4600.5,
						  4600.7,
						  4603.5,
						  5307.3, Labor
						  Code. Reference: Sections
						  4600,
						  4600.5, Labor
						  Code.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 4 - Certification Standards for Health Care Organizations › Section 9779.9 - Late Payment. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
						section filed 2-14-96; operative 2-14-96. Submitted to OAL for printing only
						pursuant to Government Code section
						11351
						(Register 96, No. 7).
2. Repealer filed 11-4-2009; operative
						1-1-2010 (Register 2009, No. 45).
Note: Authority: Sections
						  133,
						  4600.5,
						  4600.7,
						  4603.5,
						  5307.3, Labor
						  Code. Reference: Sections
						  4600,
						  4600.5, Labor
						  Code.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5 - Predesignation of Personal Physician; Request for Change of Physician; Reporting Duties of the Primary Treating Physician; Petition for Change of Primary Treating Physician › Section 9780 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
As used in this Article:
(a) "Claims Administrator" means a
					 self-administered insurer providing security for the payment of compensation
					 required by Divisions 4 and 4.5 of the Labor Code, a self-administered
					 self-insured employer, a self-administered joint powers authority, a
					 self-administered legally uninsured, or a third-party claims administrator for
					 a self-insured employer, insurer, legally uninsured employer, or joint powers
					 authority.
(b) "Emergency health
					 care services" means health care services for a medical condition manifesting
					 itself by acute symptoms of sufficient severity such that the absence of
					 immediate medical attention could reasonably be expected to place the patient's
					 health in serious jeopardy.
(c)
					 "Facility" means a hospital, clinic or other institution capable of providing
					 the medical, surgical, chiropractic or hospital treatment which is reasonably
					 required to cure or relieve the employee from the effects of the
					 injury.
(d) "First aid" is any
					 one-time treatment, and a follow-up visit for the purpose of observation of
					 minor scratches, cuts, burns, splinters, etc., which do not ordinarily require
					 medical care. Such one-time treatment, and follow-up visit for the purpose of
					 observation, is considered first aid, even though provided by a physician or
					 registered professional personnel.
(e) "Personal Physician" means
(1) the employee's regular physician and
					 surgeon, licensed pursuant to Chapter 5 (commencing with section
					 2000) of Division 2 of the Business
					 and Professions Code,
(2) who has
					 been the employee's primary care physician, and has previously directed the
					 medical treatment of the employee, and
(3) who retains the employee's medical
					 records, including the employee's medical history. "Personal physician"
					 includes a medical group, if the medical group is a single corporation or
					 partnership composed of licensed doctors of medicine or osteopathy, which
					 operates an integrated multispecialty medical group providing comprehensive
					 medical services predominantly for nonoccupational illnesses and
					 injuries.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5 - Predesignation of Personal Physician; Request for Change of Physician; Reporting Duties of the Primary Treating Physician; Petition for Change of Primary Treating Physician › Section 9780.1 - Employee's Predesignation of Personal Physician

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) An employee may be treated for an
					 industrial injury in accordance with section
					 4600 of the
					 Labor Code by a personal physician that the employee predesignates prior to the
					 industrial injury if the following three conditions are met:
(1) Notice of the predesignation of a
					 personal physician is in writing, and is provided to the employer prior to the
					 industrial injury for which treatment by the personal physician is sought. The
					 notice shall include the personal physician's name and business address, and
					 the name of the plan, policy, or fund providing the employee with health care
					 coverage for nonoccupational injuries or illnesses as required by subdivision
					 (a)(2) of this section. The employee may use the optional predesignation form
					 (DWC Form 9783) in section
					 9783 for this purpose.
(2) The employee has health care coverage for
					 nonoccupational injuries or illnesses on the date of injury in a plan, policy,
					 or fund as described in subdivisions (b), (c), and (d) of Labor Code section
					 4616.7.
(3) The employee's personal physician agrees
					 to be predesignated prior to the injury. The personal physician may sign the
					 optional predesignation form (DWC Form 9783) in section
					 9783 as documentation of such
					 agreement. The physician may authorize a designated employee of the physician
					 to sign the optional predesignation form on his or her behalf. If the personal
					 physician or the designated employee of the physician does not sign a
					 predesignation form, there must be other documentation that the physician
					 agrees to be predesignated prior to the injury in order to satisfy this
					 requirement.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5 - Predesignation of Personal Physician; Request for Change of Physician; Reporting Duties of the Primary Treating Physician; Petition for Change of Primary Treating Physician › Section 9780.2 - Employer's Duty to Provide First Aid and Emergency Treatment. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
						section filed 11-7-78; effective thirtieth day thereafter (Register 78, No.
						45).
2. Repealer filed 3-14-2006; operative 3-14-2006 pursuant to
						Government Code section
						11343.4
						(Register 2006, No. 11).
Note: Authority cited: Sections
						  124,
						  127,
						  133,
						  138.2,
						  138.3,
						  138.4,
						  139,
						  139.5,
						  139.6,
						  4600,
						  4601,
						  4602,
						  4603,
						  4603.2,
						  4603.5,
						  5307.3,
						  5450,
						  5451,
						  5452,
						  5453,
						  5454, and
						  5455, Labor
						  Code. Reference: Chapters 442, 709, and 1172, Statutes of 1977; Chapter 1017,
						  Statutes of 1976.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5 - Predesignation of Personal Physician; Request for Change of Physician; Reporting Duties of the Primary Treating Physician; Petition for Change of Primary Treating Physician › Section 9781 - Employee's Request for Change of Physician

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) This section shall not apply to
					 self-insured and insured employers who offer a Medical Provider Network
					 pursuant to section
					 4616 of the
					 Labor Code.
(b) Pursuant to section
					 4601 of the
					 Labor Code, and notwithstanding the 30 day time period specified in subdivision
					 (c), the employee may request a one time change of physician at any time.
(1) An employee's request for change of
					 physician pursuant to this subdivision need not be in writing. The claims
					 administrator shall respond to the employee in the manner best calculated to
					 inform the employee, and in no event later than 5 working days from receipt of
					 said request, the claims administrator shall provide the employee an
					 alternative physician, or if the employee so requests, a chiropractor or
					 acupuncturist.
(2) Notwithstanding
					 subdivision (a) of section
					 9780.1, if an employee requesting a
					 change of physician pursuant to this subdivision has notified his or her
					 employer in writing prior to the date of injury that he or she has either a
					 personal chiropractor or a personal acupuncturist, and where the employee so
					 requests, the alternative physician tendered by the claims administrator to the
					 employee shall be the employee's personal chiropractor or personal
					 acupuncturist as defined in subdivisions (b) and (c), respectively, of Labor
					 Code section
					 4601. The
					 notification to the employer must include the name and business address of the
					 chiropractor or acupuncturist. The employer shall notify its employees of the
					 requirements of this subdivision and provide its employees with an optional
					 form for notification of a personal chiropractor or acupuncturist, in
					 accordance with section
					 9880. DWC Form 9783.1 in section
					 9783.1 may be used for this
					 purpose.
(3) Except where the
					 employee is permitted to select a personal chiropractor or acupuncturist as
					 defined in subdivisions (b) and (c), respectively, of Labor Code section
					 4601, the
					 claims administrator shall advise the employee of the name and address of the
					 alternative physician, or chiropractor or acupuncturist if requested, the date
					 and time of an initial scheduled appointment, and any other pertinent
					 information.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5 - Predesignation of Personal Physician; Request for Change of Physician; Reporting Duties of the Primary Treating Physician; Petition for Change of Primary Treating Physician › Section 9782 - Notice to Employee of Right to Choose Physician

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Except for an employer who has
					 established a Medical Provider Network, or an employer whose insurer has
					 established a Medical Provider Network, every employer shall advise its
					 employees in writing of an employee's right (1) to request a change of treating
					 physician if the original treating physician is selected initially by the
					 employer pursuant to Labor Code section
					 4601, and
					 (2) to be treated by a physician of his or
					 her own choice 30 days after reporting an injury pursuant to subdivision (c) of
					 Labor Code
					 4600.
(b) Every employer shall advise its employees
					 in writing of an employee's right to predesignate a personal physician pursuant
					 to subdivision (d) of Labor Code section
					 4600, and section
					 9780.1.
(c) The notices required by this section
					 shall be provided in accordance with section
					 9880 and posted in accordance with
					 section 9881.
1.
						Repealer and new section filed 11-9-77; effective thirtieth day thereafter
						(Register 77, No. 46).
2. Repealer and new section filed 11-7-78;
						effective thirtieth day thereafter (Register 78, No. 45).
3.
						Amendment of section and NOTE filed 3-14-2006; operative 3-14-2006 pursuant to
						Government Code section
						11343.4
						(Register 2006, No. 11).
Note: Authority cited: Sections
						  133 and
						  4603.5, Labor
						  Code. Reference: Sections
						  3550,
						  3551,
						  4600,
						  4601 and
						  4616, Labor
						  Code.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5 - Predesignation of Personal Physician; Request for Change of Physician; Reporting Duties of the Primary Treating Physician; Petition for Change of Primary Treating Physician › Section 9784 - Duties of the Employer. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1.
						Repealer and new section filed 11-9-77; effective thirtieth day thereafter
						(Register 77, No. 46).
2. Amendment filed 11-11-78; effective
						thirtieth day thereafter (Register 78, No. 45).
3. Repealer filed
						3-14-2006; operative 3-14-2006 pursuant to Government Code section
						11343.4
						(Register 2006, No. 11).
Note: Authority cited: Sections
						  124,
						  127,
						  133,
						  138.2,
						  138.3,
						  138.4,
						  139,
						  139.5,
						  139.6,
						  4600,
						  4601,
						  4602,
						  4603,
						  4603.2,
						  4603.5,
						  5307.3,
						  5450,
						  5451,
						  5452,
						  5453,
						  5454, and
						  5455, Labor
						  Code. Reference: Chapters 442, 709, and 1172, Statutes of 1977; Chapter 1017,
						  Statutes of 1976.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5 - Predesignation of Personal Physician; Request for Change of Physician; Reporting Duties of the Primary Treating Physician; Petition for Change of Primary Treating Physician › Section 9785.2 - Form PR-2 "Primary Treating Physician's Progress Report."

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
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1. New
						section filed 11-9-98; operative 1-1-99 (Register 98, No. 46).
2.
						Repealer and new form filed 12-22-2000; operative 1-1-2001 pursuant to
						Government Code section
						11343.4(d)
						(Register 2000, No. 51).
3. Amendment of form filed 5-20-2003;
						operative 6-19-2003 (Register 2003, No. 21).
4. Amendment of section
						and NOTE filed 12-31-2004 as an emergency; operative 1-1-2005 (Register 2004,
						No. 53). A Certificate of Compliance must be transmitted to OAL by 5-2-2005 or
						emergency language will be repealed by operation of law on the following
						day.
5. Certificate of Compliance as to 12-31-2004 order, including
						further amendment of section, transmitted to OAL 4-29-2005 and filed 6-10-2005
						(Register 2005, No. 23).
Note: Authority cited: Sections
						  133,
						  4603.5 and
						  5307.3, Labor
						  Code. Reference: Sections
						  4061.5,
						  4600,
						  4603.2,
						  4610,
						  4636,
						  4660,
						  4662,
						  4663 and
						  4664, Labor
						  Code.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5 - Predesignation of Personal Physician; Request for Change of Physician; Reporting Duties of the Primary Treating Physician; Petition for Change of Primary Treating Physician › Section 9785.2.1 - Form PR-2 "Primary Treating Physician Progress Report" - Services on or After October 1, 2015

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
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1. New
						section filed 9-21-2015; operative 10-1-2015 pursuant to Government Code
						section
						11343.4(b)(3)
						(Register 2015, No. 39).
Note: Authority cited: Sections
						  133,
						  4603.5 and
						  5307.3, Labor
						  Code. Reference: Sections
						  4061.5,
						  4600,
						  4603.2,
						  4610,
						  4636,
						  4660,
						  4662,
						  4663 and
						  4664, Labor
						  Code.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5 - Predesignation of Personal Physician; Request for Change of Physician; Reporting Duties of the Primary Treating Physician; Petition for Change of Primary Treating Physician › Section 9785.3.1 - Form PR-3 "Primary Treating Physician's Permanent and Stationary Report" - Services on or After October 1, 2015

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
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1. New
						section filed 9-21-2015; operative 10-1-2015 pursuant to Government Code
						section
						11343.4(b)(3)
						(Register 2015, No. 39).
Note: Authority cited: Sections
						  133,
						  4603.5 and
						  5307.3, Labor
						  Code. Reference: Sections
						  4061.5,
						  4600,
						  4603.2,
						  4636,
						  4660,
						  4662,
						  4663 and
						  4664, Labor
						  Code.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5 - Predesignation of Personal Physician; Request for Change of Physician; Reporting Duties of the Primary Treating Physician; Petition for Change of Primary Treating Physician › Section 9785.4.1 - Form PR-4 "Primary Treating Physician's Permanent and Stationary Report" - Services on or After October 1, 2015

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
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1. New
						section filed 9-21-2015; operative 10-1-2015 pursuant to Government Code
						section
						11343.4(b)(3)
						(Register 2015, No. 39).
2. Change without regulatory effect
						updating form filed 3-4-2016 pursuant to section
						100, title 1, California Code of
						Regulations (Register 2016, No. 10).
Note: Authority cited: Sections
						  133 and
						  5307.3, Labor
						  Code. Reference: Sections
						  4061.5,
						  4600,
						  4603.2,
						  4604.5,
						  4636,
						  4660,
						  4662,
						  4663 and
						  4664, Labor
						  Code.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5 - Predesignation of Personal Physician; Request for Change of Physician; Reporting Duties of the Primary Treating Physician; Petition for Change of Primary Treating Physician › Section 9785.5 - Request for Authorization Form, DWC Form RFA

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
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1. New
						section filed 12-31-2012 as an emergency; operative 1-1-2013 pursuant to
						Government Code section
						11346.1(d)
						(Register 2013, No. 1). A Certificate of Compliance must be transmitted to OAL
						by 7-1-2013 or emergency language will be repealed by operation of law on the
						following day. For prior history, see Register 98, No. 46.
2. New
						section refiled 7-1-2013 as an emergency; operative 7-1-2013 (Register 2013,
						No. 27). A Certificate of Compliance must be transmitted to OAL by 9-30-2013 or
						emergency language will be repealed by operation of law on the following
						day.
3. New section refiled 9-30-2013 as an emergency; operative
						10-1-2013 (Register 2013, No. 40). A Certificate of Compliance must be
						transmitted to OAL by 12-30-2013 or emergency language will be repealed by
						operation of law on the following day.
4. Certificate of Compliance
						as to 9-30-2013 order, including repealer and new section, transmitted to OAL
						12-30-2013 and filed 2-12-2014; new section effective 2-12-2014 pursuant to
						Government Code section
						11343.4(b)(3)
						(Register 2014, No. 7).
Note: Authority cited: Sections
						  133,
						  4603.5 and
						  5307.3, Labor
						  Code. Reference: Sections
						  4061,
						  4061.5,
						  4062,
						  4600,
						  4604.5,
						  4610,
						  4610.5 and
						  4610.6, Labor
						  Code.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5 - Predesignation of Personal Physician; Request for Change of Physician; Reporting Duties of the Primary Treating Physician; Petition for Change of Primary Treating Physician › Section 9786 - Petition for Change of Primary Treating Physician

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A claims administrator desiring a change
					 of primary treating physician pursuant to Labor Code Section
					 4603 shall file
					 with the Administrative Director a petition, verified under penalty of perjury,
					 on the "Petition for Change of Primary Treating Physician" form (DWC-Form 280
					 (Part A)) contained in Section
					 9786.1.
The petition shall be accompanied by supportive
						documentary evidence relevant to the specific allegations raised. A proof of
						service by mail declaration shall be attached to the petition indicating that
						(1) the completed petition (Part A), (2) the supportive documentary evidence
						and (3) a blank copy of the "Response to Petition for Change of Primary
						Treating Physician", (DWC-Form 280 (Part B)), were served on the employee or,
						the employee's attorney, and the employee's current primary treating
						physician.
(b) Good cause to
					 grant the petition shall be clearly shown by verified statement of facts, and,
					 where appropriate, supportive documentary evidence. Good cause includes, but is
					 not limited to any of the following:
(1) The
					 primary treating physician has failed to comply with Section
					 9785, subdivisions (e), (f)(1-7),
					 or (g) by not timely submitting a required report or submitting a report which
					 is inadequate due to material omissions or deficiencies;
(2) The primary treating physician has failed
					 to comply with subdivision (f)(8) of Section
					 9785 by failing to submit timely or
					 complete progress reports on two or more occasions within the 12-month period
					 immediately preceding the filing of the petition;
(3) A clear showing that the current
					 treatment is not consistent with the treatment plan submitted pursuant to
					 Section 9785, subdivisions (e) or
					 (f);
(4) A clear showing that the
					 primary treating physician or facility is not within a reasonable geographic
					 area as determined by Section
					 9780(e).
(5) A clear showing that the primary treating
					 physician has a possible conflict of interest, including but not limited to a
					 familial, financial or employment relationship with the employee, which has a
					 significant potential for interfering with the physician's ability to engage in
					 objective and impartial medical decision making.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5 - Predesignation of Personal Physician; Request for Change of Physician; Reporting Duties of the Primary Treating Physician; Petition for Change of Primary Treating Physician › Section 9786.1 - Petition for Change of Primary Treating Physician; Response to Petition for Change of Primary Treating Physician (DWC Form 280 (Parts a and B))

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
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1. New
						section (DWC form 280) filed 12-22-2000; operative 1-1-2001 pursuant to
						Government Code section
						11343.4(d)
						(Register 2000, No. 51).
Note: Authority cited: Sections
						  133,
						  139.5,
						  4603,
						  4603.2,
						  4603.5, and
						  5307.3, Labor
						  Code. Reference: Sections
						  4600,
						  4603 and
						  4603.2, Labor
						  Code.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5 - Predesignation of Personal Physician; Request for Change of Physician; Reporting Duties of the Primary Treating Physician; Petition for Change of Primary Treating Physician › Section 9787 - Appeal from Administrative Director's Order Granting or Denying Petition for Change of Primary Treating Physician

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Any order denying or granting the claims administrator's
						petition whether issued with or without hearing, shall be final and binding
						upon the parties unless within 20 days from service thereof the aggrieved party
						petitions the Workers' Compensation Appeals Board for relief in the manner
						prescribed by Section
						10950 of the Board's Rules of
						Practice and Procedure.
1.
						Repealer and new section filed 11-9-77; effective thirtieth day thereafter
						(Register 77, No. 46).
2. Amendment of section heading and section
						filed 12-22-2000; operative 1-1-2001 pursuant to Government Code section
						11343.4(d)
						(Register 2000, No. 51).
3. Amendment of section and new NOTE filed
						5-20-2003; operative 6-19-2003 (Register 2003, No.
						21).
Note: Authority cited: Sections
						  133,
						  139.5,
						  4603.2,
						  4603.5 and
						  5307.3, Labor
						  Code. Reference: Sections
						  4600,
						  4603 and
						  4603.2, Labor
						  Code.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5.1 - Provider Suspension Procedure › Section 9788.01 - Definitions [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Note: Authority cited: Sections
						  133,
						  5307.1 and
						  5307.3, Labor
						  Code. Reference: Sections
						  4062(b)
						  and
						  4600, Labor
						  Code.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5.1 - Provider Suspension Procedure › Section 9788.1 - Notice of Provider Suspension

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The Administrative Director shall issue a
					 notice of suspension to a physician, practitioner, or provider who has met one
					 of the criteria set forth under Labor Code section
					 139.21(a)(1).
(b) The term "suspension from participation"
					 means the physician, practitioner, or provider is prohibited from providing any
					 goods or services related to an occupational injury or illness that is either
					 for pay or required by Labor Code sections
					 4060,
					 4061,
					 4062,
					 4062.1,
					 4062.2,
					 4600,
					 4600.3,
					 4610,
					 4610.5,
					 4610.6,
					 4616, and
					 4620. The term
					 "suspension from participation" also precludes a physician's continued
					 certification as a qualified medical evaluator pursuant to Labor Code section
					 139.2.
(c) The physician, practitioner, or provider
					 is prohibited from seeking payment or reimbursement, either directly or
					 indirectly, for any goods or services related to an occupational injury or
					 illness that is provided on or after the date of their suspension.
(d) The notice required under subdivision (a)
					 shall be in writing and shall include all of the following:
(1) Notice that the physician, practitioner,
					 or provider is subject to suspension from participating in the workers'
					 compensation system;
(2) The basis
					 for the suspension under Labor Code section
					 139.21(a)(1);
(3) A statement that the suspension is
					 effective 30 days from the date the notice is mailed, unless the physician,
					 practitioner, or provider requests a hearing and, in that hearing, provides
					 proof that Labor Code section
					 139.21(a)(1)
					 is not applicable;
(4) A statement
					 that the physician, practitioner, or provider may request a hearing within 10
					 days from the date the notice is served, which will stay the suspension pending
					 the outcome of the hearing, and that the failure to request a hearing will
					 result in suspension pursuant to section
					 9788.2(b);
					 and
(5) A description of the method
					 for requesting the hearing, including instructions on how the request should be
					 filed and served.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5.1 - Provider Suspension Procedure › Section 9788.11 - Form for Employer's Objection To Report Of Treating Physician Recommending Spinal Surgery [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Note: Authority cited: Sections
						  133 and
						  5307.3, Labor
						  Code. Reference: Sections
						  4062(b)
						  and
						  4600, Labor
						  Code.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5.1 - Provider Suspension Procedure › Section 9788.31 - Application Form [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Note: Authority cited: Sections
						  133 and
						  5307.3, Labor
						  Code. Reference: Sections
						  4062(b)
						  and
						  4600, Labor
						  Code
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5.1 - Provider Suspension Procedure › Section 9788.32 - Administrative Director's Action on Application [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Note: Authority cited: Sections
						  133 and
						  5307.3, Labor
						  Code; and Sections
						  11400.20
						  and
						  11415.10,
						  Government Code. Reference: Sections
						  4062(b)
						  and
						  4600, Labor
						  Code.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5.1 - Provider Suspension Procedure › Section 9788.4 - Suspension Notification

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Following the date that the Determination
					 and Order re: Suspension is final, the Administrative Director shall provide
					 written notification of the physician's, practitioner's, or provider's
					 suspension from participating in the workers' compensation system to:
(1) The Chief Judge of the Division of
					 Workers' Compensation. Upon notification, the Chief Judge shall provide written
					 notification of the suspension to the district offices of the Division of
					 Workers' Compensation and all Administrative Law Judges employed by the
					 Division.
(2) The special lien
					 proceeding attorney designated under Labor Code section
					 139.21(f),
					 if one is appointed.
(3) The
					 physician's, practitioner's, or provider's state licensing, certifying, or
					 registering authority.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5.1 - Provider Suspension Procedure › Section 9788.45 - Unavailability of Second Opinion Physician [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Note: Authority cited: Sections
						  133 and
						  5307.3, Labor
						  Code. Reference: Sections
						  4062(b)
						  and
						  4600, Labor
						  Code.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5.1 - Provider Suspension Procedure › Section 9788.5 - Amendment of the Order of Suspension or Determination and Order RE: Suspension

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
If the Administrative Director becomes aware that a
						suspended physician, practitioner, or provider would be subject to suspension
						under Labor Code section
						139.21(a)(1)
						for a criminal conviction or other statutory basis that did not serve as the
						basis for the suspension in the original Order of Suspension or Determination
						and Order re: Suspension, the Administrative Director may issue an amended
						Order of Suspension or amended Determination and Order re: Suspension following
						written notice to the physician, practitioner, or provider pursuant to section
						9788.1 and an opportunity for
						hearing pursuant to sections
						9788.2 and
						9788.3.
1. New
						section filed 2-7-2018; operative 2-7-2018 pursuant to Government Code section
						11343.4(b)(3)
						(Register 2018, No. 6).
Note: Authority cited: Sections
						  133 and
						  139.21, Labor
						  Code. Reference: Section
						  139.21, Labor
						  Code.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5.1 - Provider Suspension Procedure › Section 9788.6 - Service and Computation of Time

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) In the case of service by mail, the
					 notice or other paper shall be complete at the time of mailing.
(b) All documents shall be considered "filed"
					 when the original is actually received by the Division of Workers' Compensation
					 or the hearing officer designated to hear the case, where
					 appropriate.
(c) A five day
					 extension of time shall apply to any filing made in response to documents
					 served by mail if the place of address is within the State of California, ten
					 days if the place of address is outside the State of California but within the
					 United States, and twenty days if the place of address is outside the United
					 States.
1. New
						section filed 2-7-2018; operative 2-7-2018 pursuant to Government Code section
						11343.4(b)(3)
						(Register 2018, No. 6).
Note: Authority cited: Sections
						  133 and
						  139.21, Labor
						  Code. Reference: Section
						  139.21, Labor
						  Code; and Section
						  1013,
						  Code of Civil Procedure.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5.1 - Provider Suspension Procedure › Section 9788.7 - Contents of Second Opinion and Agreed Second Opinion Physician Reports [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Note: Authority cited: Sections
						  133 and
						  5307.3, Labor
						  Code. Reference: Sections
						  4062(b)
						  and
						  4600, Labor
						  Code.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5.1 - Provider Suspension Procedure › Section 9788.8 - Time Limits For Providing Reports [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Note: Authority cited: Sections
						  133 and
						  5307.3, Labor
						  Code. Reference: Sections
						  4062(b)
						  and
						  4600, Labor
						  Code
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5.1 - Provider Suspension Procedure › Section 9788.9 - Charges for Services of Second Opinion Physician and Agreed Second Opinion Physician [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Note: Authority cited: Sections
						  133 and
						  5307.3, Labor
						  Code. Reference: Sections
						  4062(b)
						  and
						  4600, Labor
						  Code.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5.1 - Provider Suspension Procedure › Section 9788.91 - Filing of a Declaration of Readiness to Proceed [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Note: Authority cited: Sections
						  133 and
						  5307.3, Labor
						  Code. Reference: Sections
						  4062(b)
						  and
						  4600, Labor
						  Code.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5.3 - Official Medical Fee Schedule › Section 9789.11 - Physician Services Rendered on or After July 1, 2004, but Before January 1, 2014

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Except
					 as specified below, or otherwise provided in this Article, the ground rule
					 materials set forth in each individual section of the OMFS 2003 are applicable
					 to physician services rendered on or after July 1, 2004, but before January 1,
					 2014.
(1) The OMFS 2003's "General Information
					 and Instructions" section is not applicable. The "General Information and
					 Instructions, Effective for Dates of Service on or after July 1, 2004," are
					 incorporated by reference and will be made available on the Division of
					 Workers' Compensation Internet site
http://www.dir.ca.gov/DWC/OMFS9904.htm
or upon request to the Administrative Director at:
DIVISION OF WORKERS' COMPENSATION (ATTENTION: OMFS -
						PHYSICIAN SERVICES)
P.O. BOX 420603
SAN FRANCISCO, CA 94142
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5.3 - Official Medical Fee Schedule › Section 9789.12.1 - Physician Fee Schedule: Official Medical Fee Schedule for Physician and Non-Physician Practitioner Services - for Services Rendered on or After January 1, 2014

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Maximum reasonable fees for physician and non-physician practitioner medical
					 treatment provided pursuant to Labor Code section
					 4600, which is
					 rendered on or after January 1, 2014, shall be no more than the amount
					 determined by the Official Medical Fee Schedule for Physician and Non-Physician
					 Practitioners, consisting of the regulations set forth in Sections
					 9789.12.1 through
					 9789.19.1 ("Physician Fee
					 Schedule.") Maximum fees for services rendered prior to January 1, 2014 shall
					 be determined in accordance with the fee schedule in effect at the time the
					 service was rendered. The Physician Fee Schedule shall not govern fees for
					 services covered by a contract setting such fees as permitted by Labor Code
					 section
					 5307.11.
(b) Maximum fees for services of a physician
					 or non-physician practitioner are governed by the Physician Fee Schedule,
					 regardless of specialty, for services performed within his or her scope of
					 practice or license as defined by California law, except:
(1) Evaluation and management codes are to be
					 used only by physicians (as defined by Labor Code §
												3209.3), as
					 well as physician assistants and nurse practitioners who are acting within the
					 scope of their practice and are under the direction of a supervising
					 physician.
(2) Osteopathic
					 Manipulation Codes (98925-98929) are to be used only by licensed Doctors of
					 Osteopathy and Medical Doctors.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 5.3 - Official Medical Fee Schedule › Section 9789.12.3 - Status Codes C, I, N and R

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Except as otherwise provided in this fee
					 schedule, for physician and nonphysician practitioner services billed using
					 Current Procedural Terminology (CPT) codes, the RVUs listed in the Centers for
					 Medicare and Medicaid Services (CMS') National Physician Fee Schedule Relative
					 Value File will be utilized regardless of status code.
(b) When procedures with status indicator
					 codes C, N, or R, do not have RVUs assigned under the CMS' National Physician
					 Fee Schedule Relative Value File, these services shall be reimbursed By
					 Report.
(c)
(1) CPT codes with status indicator code I,
					 where Medicare uses another CPT code for reporting and payment for these
					 services shall be reimbursed according to the other CPT code used by
					 Medicare.
(2) Healthcare Common
					 Procedure Coding System (HCPCS) "J" procedures with status indicator I shall be
					 reimbursed according to section
					 9789.13.2.
(3) CPT codes with status indicator code I,
					 where Medicare uses HCPCS "J" code for reporting and payment for these
					 services, shall be reimbursed according to section
					 9789.13.2.
(4) Maximum reasonable fee for procedures
					 with status indicator code I, that do not meet the criteria of subdivisions
					 (c)(1), (c)(2), or (c)(3) shall be determined as follows:
(A) use the RVUs listed in the CMS' National
					 Physician Fee Schedule Relative Value File;
(B) If (c)(4)(A) is not applicable, use the
					 applicable fee schedule contained in sections
					 9789.30-9789.70;
(C) If (c)(4)(A) or (B) are not applicable,
					 payable By Report.