California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 1 - Division of Workers' Compensation - Qualified Medical Evaluator Regulations › Article 3 - Assignment of Qualified Medical Evaluators, Evaluation Procedure › Section 36.5 - Service of Comprehensive Medical/Legal Report in Claims of Injury to the Psyche

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) For
				  any evaluation involving a claimed or disputed injury to the psyche, the
				  injured worker shall be advised by the evaluator that the employee's copy of
				  the comprehensive medical-legal report, and any follow up or supplemental
				  reports, from the evaluation may be served either directly on the injured
				  worker or instead on a physician designated in writing by the injured worker
				  prior to leaving the evaluator's office, for the purpose of reviewing and
				  discussing the evaluation report with the injured worker. The evaluator shall
				  explain that the designated physician may be but need not be the injured
				  worker's primary treating physician in the workers' compensation claim and that
				  the employer will be responsible for payment for one office visit with the
				  designated physician for this purpose.
(b) Whenever injury to the psyche is claimed
				  and in the course of the evaluation, the evaluator makes a determination
				  pursuant to Health and Safety Code section
				  123115(b)
				  that there is a substantial risk of significant adverse or detrimental medical
				  consequences to the injured worker from seeing or receiving a copy of part or
				  all of evaluation report which is a mental health record, the evaluator shall
				  do all of the following:
(1) Complete QME Form
				  121 (Declaration Regarding Protection of Mental Health Record);
(2) Advise the injured worker that the
				  determination under Health and Safety Code 123115(b) has been made regarding
				  the evaluation report as a mental health record and that the evaluator only may
				  serve the injured worker's copy of the evaluation report on a person who is a
				  licensed physician, as defined in Labor Code section
				  3209.3, whose
				  name the injured worker may designate in writing prior to leaving the
				  evaluator's office, or on the employee's attorney, if any;
(3) Permit inspection and copying of the
				  mental health record(s) subject to the Health and Safety Code section
				  123115(b)
				  determination, only by a licensed physician as defined in Labor Code section
				  3209.3 or
				  another health care provider as defined in Health and Safety Code section
				  123105(a);
(4) Complete the QME Form 121 and enter the
				  name and address of the physician designated in writing by the injured worker
				  on this form;
(5) Attach a
				  completed copy of QME Form 121 (Declaration Regarding Protection of Mental
				  Health Record) to the copy of the evaluation report in the injured worker's
				  medical or medical-legal file;
(6)
				  Serve the completed comprehensive medical-legal evaluation report, follow-up
				  medical-legal report or supplemental medical-legal report(s) subject to the
				  provisions of this section, with the completed QME Form 121 (Declaration
				  Regarding Protection of Mental Health Record) attached, on the licensed
				  physician designated by the injured worker on QME Form 121, and on the claims
				  administrator, and on each party's attorney, if any, as provided in section
				  36, and within the time periods in
				  section 38, of Title 8 of the California
				  Code of Regulations. In the event the injured worker designates a physician on
				  QME Form 121 other than the current primary treating physician in his or her
				  workers' compensation claim, the evaluator shall also serve a copy of the
				  report with the QME Form 121 attached on the primary treating
				  physician;
(7) Whenever the report
				  addresses any permanent impairment, permanent disability or apportionment and
				  the injured worker is not represented by an attorney, a copy of the report with
				  the completed QME Form 121 attached shall also be served on the appropriate
				  office of the Disability Evaluation Unit, along with the QME Form 111 (QME's
				  Findings Summary Form), and DWC-AD form 100 (DEU) (Employee's Disability
				  Questionnaire)(See, 8 Cal. Code Regs. §§
											10160 and
				  10161) and DWC-AD form 101 (DEU)
				  (Request for Summary Rating Determination of Qualified Medical Evaluator's
				  Report)(See, 8 Cal. Code Regs. §§
											10160 and
				  10161), with the document cover
				  sheet, DWC-CA form 10232.1 (see, 8 Cal. Code Regs. §
											10232.1), and separator sheet,
				  DWC-CA form 10232.2 (see, 8 Cal. Code Regs. §
											10232.2), as required by Title 8,
				  California Code of Regulations section
				  10160(d)(4);
(8) Whenever the report addresses permanent
				  impairment, permanent disability or apportionment and the injured worker is
				  represented by an attorney, a copy of the report with the completed QME Form
				  121 attached shall be served with QME Form 122 (AME or QME Declaration of
				  Service of Medical-Legal Report) on the physician designated by the injured
				  worker, the injured worker's attorney and on the claims administrator's
				  attorney, or if none on the claims administrator.