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 - Reporting Duties of the Primary Treating Physician

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) For the purposes of this section, the
					 following definitions apply:
(1) The "primary
					 treating physician" is the physician who is primarily responsible for managing
					 the care of an employee, and who has examined the employee at least once for
					 the purpose of rendering or prescribing treatment and has monitored the effect
					 of the treatment thereafter. The primary treating physician is the physician
					 selected by the employer, the employee pursuant to Article 2 (commencing with
					 section 4600) of Chapter 2 of Part 2 of
					 Division 4 of the Labor Code, or under the contract or procedures applicable to
					 a Health Care Organization certified under section
					 4600.5 of the
					 Labor Code, or in accordance with the physician selection procedures contained
					 in the medical provider network pursuant to Labor Code section
					 4616. For
					 injuries on or after January 1, 2004, a chiropractor shall not be a primary
					 treating physician after the employee has received 24 chiropractic visits,
					 unless the employer has authorized additional visits in writing. This
					 prohibition shall not apply to the provision of postsurgical physical medicine
					 prescribed by the employee's surgeon, or physician designated by the surgeon
					 pursuant to the postsurgical component of the medical treatment utilization
					 schedule adopted by the Administrative Director pursuant to Labor Code section
					 5307.27. For
					 purposes of this subdivision, the term "chiropractic visit" means any
					 chiropractic office visit, regardless of whether the services performed involve
					 chiropractic manipulation or are limited to evaluation and
					 management.
(2) A "secondary
					 physician" is any physician other than the primary treating physician who
					 examines or provides treatment to the employee, but is not primarily
					 responsible for continuing management of the care of the employee. For injuries
					 on or after January 1, 2004, a chiropractor shall not be a secondary treating
					 physician after the employee has received 24 chiropractic visits, unless the
					 employer has authorized, in writing, additional visits. This prohibition shall
					 not apply to the provision of postsurgical physical medicine prescribed by the
					 employee's surgeon, or physician designated by the surgeon pursuant to the
					 postsurgical component of the medical treatment utilization schedule adopted by
					 the Administrative Director pursuant to Labor Code section
					 5307.27. For
					 purposes of this subdivision, the term "chiropractic visit" means any
					 chiropractic office visit, regardless of whether the services performed involve
					 chiropractic manipulation or are limited to evaluation and
					 management.
(3) "Claims
					 administrator" is 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, or a third-party administrator for a
					 self-insured employer, insurer, legally uninsured employer, or joint powers
					 authority.
(4) "Medical
					 determination" means, for the purpose of this section, 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.
(5) "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.
(6)
					 "Continuing medical treatment" is occurring or presently planned treatment that
					 is reasonably required to cure or relieve the employee from the effects of the
					 injury.
(7) "Future medical
					 treatment" is 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.
(8) "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.