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 5.5.1 - Utilization Review Standards › Section 9792.8 - Utilization Review Standards-Medically-Based Criteria

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
(1) The
					 criteria shall be consistent with the schedule for medical treatment
					 utilization adopted pursuant to Labor Code section
					 5307.27. Prior
					 to adoption of the schedule, the criteria or guidelines used in the utilization
					 review process shall be consistent with the American College of Occupational
					 and Environmental Medicine's (ACOEM) Practice Guidelines, Second Edition. The
					 guidelines set forth in the ACOEM Practice Guidelines shall be presumptively
					 correct on the issue of extent and scope of medical treatment until the
					 effective date of the utilization schedule adopted pursuant to Labor Code
					 section
					 5307.27. The
					 presumption is rebuttable and may be controverted by a preponderance of the
					 scientific medical evidence establishing that a variance from the guidelines is
					 reasonably required to cure or relieve the injured worker from the effects of
					 his or her injury.
(2) For all
					 conditions or injuries not addressed by the ACOEM Practice Guidelines or by the
					 official utilization schedule after adoption pursuant to Labor Code section
					 5307.27,
					 authorized treatment shall be in accordance with other evidence-based medical
					 treatment guidelines that are generally recognized by the national medical
					 community and are scientifically based. Treatment may not be denied on the sole
					 basis that the treatment is not addressed by the ACOEM Practice Guidelines
					 until adoption of the medical treatment utilization schedule pursuant to Labor
					 Code section
					 5307.27. After
					 the Administrative Director adopts a medical treatment utilization schedule
					 pursuant to Labor Code section
					 5307.27,
					 treatment may not be denied on the sole basis that the treatment is not
					 addressed by that schedule.
(3) The
					 relevant portion of the criteria or guidelines used shall be disclosed in
					 written form to the requesting physician, the injured worker, and if the
					 injured worker is represented by counsel, the injured worker's attorney, if
					 used as the basis of a decision to modify, delay, or deny services in a
					 specific case under review. The claims administrator may not charge an injured
					 worker, the injured worker's attorney or the requesting physician for a copy of
					 the relevant portion of the criteria or guidelines used to modify, delay or
					 deny the treatment request.
(4)
					 Nothing in this section precludes authorization of medical treatment not
					 included in the specific criteria under section
					 9792.8(a)(3).
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 5.5.1 - Utilization Review Standards › Section 9792.9 - Utilization Review Standards-Timeframe, Procedures and Notice Content - for Injuries Occurring Prior to January 1, 2013, Where the Request for Authorization is Received Prior to July 1, 2013

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
This section applies to any request for authorization of
						medical treatment, submitted under Article 5.5.1 of this Subchapter, for an
						occupational injury or illness occurring prior to January 1, 2013 where the
						request for authorization is received prior to July 1, 2013.
(a) The request for authorization for a
					 course of treatment as defined in section
					 9792.6(e) must be
					 in written form.
(1) For purposes of this
					 section, the written request for authorization shall be deemed to have been
					 received by the claims administrator by facsimile on the date the request was
					 received if the receiving facsimile electronically date stamps the
					 transmission. If there is no electronically stamped date recorded, then the
					 date the request was transmitted. A request for authorization transmitted by
					 facsimile after 5:30 PM Pacific Time shall be deemed to have been received by
					 the claims administrator on the following business day as defined in Labor Code
					 section
					 4600.4 and in
					 section
					 9 of the Civil
					 Code. The copy of the request for authorization received by a facsimile
					 transmission shall bear a notation of the date, time and place of transmission
					 and the facsimile telephone number to which the request was transmitted or be
					 accompanied by an unsigned copy of the affidavit or certificate of transmission
					 which shall contain the facsimile telephone number to which the request was
					 transmitted. The requesting physician must indicate the need for an expedited
					 review upon submission of the request.
(2) Where the request for authorization is
					 made by mail, and a proof of service by mail exists, the request shall be
					 deemed to have been received by the claims administrator five (5) days after
					 the deposit in the mail at a facility regularly maintained by the United States
					 Postal Service. Where the request for authorization is delivered via certified
					 mail, return receipt mail, the request shall be deemed to have been received by
					 the claims administrator on the receipt date entered on the return receipt. In
					 the absence of a proof of service by mail or a dated return receipt, the
					 request shall be deemed to have been received by the claims administrator on
					 the date stamped as received on the document.
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 5.5.1 - Utilization Review Standards › Section 9792.10 - Utilization Review Standards-Dispute Resolution - for Utilization Review Decisions Communicated Prior to July 1, 2013 for Injuries Occurring Prior to January 1, 2013

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
This section applies to any request for authorization of
						medical treatment, made under Article 5.5.1 of this Subchapter, for an
						occupational injury or illness occurring prior to January 1, 2013 if the
						decision on the request is communicated to the requesting physician prior to
						July 1, 2013.
(a)
(1) If the request for authorization of
					 medical treatment is not approved, or if the request for authorization for
					 medical treatment is approved in part, any dispute shall be resolved in
					 accordance with Labor Code section
					 4062.
(2) An objection to a decision disapproving
					 in whole or in part a request for authorization of medical treatment, must be
					 communicated to the claims administrator by the injured worker or the injured
					 worker's attorney in writing within 20 days of receipt of the utilization
					 review decision. The 20-day time limit may be extended for good cause or by
					 mutual agreement of the parties.
(3) Nothing in this paragraph precludes the
					 parties from participating in an internal utilization review appeal process on
					 a voluntary basis provided the injured worker and if the injured worker is
					 represented by counsel, the injured worker's attorney have been notified of the
					 20-day time limit to file an objection to the utilization review decision in
					 accordance with Labor Code section
					 4062.
(4) Additionally, the injured worker or the
					 injured worker's attorney may file an Application for Adjudication of Claim and
					 request an expedited hearing and decision on his or her entitlement to medical
					 treatment if the request for medical treatment is not authorized within the
					 time limitations set forth in section
					 9792.9, or when there exists a bona
					 fide dispute as to entitlement to medical treatment.
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 5.5.1 - Utilization Review Standards › Section 9792.10.2 - Application for Independent Medical Review, DWC Form IMR

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.
2. New section refiled 7-1-2013 as an emergency,
						including further amendment of form; 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, including
						further amendment of form; 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: Sections
						  133,
						  4603.5,
						  4610.5 and
						  5307.3, Labor
						  Code. Reference: Sections
						  4600,
						  4610 and
						  4610.5, 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 5.5.1 - Utilization Review Standards › Section 9792.10.3 - Independent Medical Review - Initial Review of Application

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Following receipt of the Application for
					 Independent Medical Review, DWC Form IMR, pursuant to section
					 9792.10.1(b), the
					 Administrative Director shall determine whether the disputed medical treatment
					 identified in the application is eligible for independent medical review. In
					 making this determination, the Administrative Director shall consider:
(1) The timeliness and completeness of the
					 Application;
(2) Any previous
					 application or request for independent medical review of the disputed medical
					 treatment;
(3) Any assertion, other
					 than medical necessity, by the claims administrator that a factual, medical, or
					 legal basis exists that precludes liability on the part of the claims
					 administrator for an occupational injury or a claimed injury to any part or
					 parts of the body.
(4) Any
					 assertion, other than medical necessity, by the claims administrator that a
					 factual, medical, or legal basis exists that precludes liability on the part of
					 the claims administrator for a specific course of treatment requested by the
					 treating physician.
(5) The
					 employee's date of injury.
(6) The
					 failure by the requesting physician to respond to a request by the claims
					 administrator under section
					 9792.9.1(f) for
					 information reasonably necessary to make a utilization review determination,
					 for additional required examinations or tests, or for a specialized
					 consultation.
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 5.5.1 - Utilization Review Standards › Section 9792.10.5 - Independent Medical Review - Medical Records

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
(1)
					 Within fifteen (15) days following the mailing of the notification from the
					 independent review organization that the disputed medical treatment has been
					 assigned for independent medical review, or within twelve (12) days if the
					 notification was sent electronically, or for expedited review within
					 twenty-four (24) hours following receipt of the notification, the independent
					 medical review organization shall receive from the claims administrator all of
					 the following documents:
(A) A copy of all
					 reports of the physician relevant to the employee's current medical condition
					 produced within six months prior to the date of the request for authorization,
					 including those that are specifically identified in the request for
					 authorization or in the utilization review determination. If the requesting
					 physician has treated the employee for less than six months prior to the date
					 of the request for authorization, the claims administrator shall provide a copy
					 of all reports relevant to the employee's current medical condition produced
					 within the described six month period by any prior treating physician or
					 referring physician.
(B) A copy of
					 the written Application for Independent Medical Review, DWC Form IMR, that was
					 included with the written determination, issued under section
					 9792.9.1(e)(5),
					 which notified the employee that the disputed medical treatment was denied,
					 delayed or modified. Neither the written determination nor the application's
					 instructions should be included.
(C) Other than the written determination by
					 the claims administrator issued under section
					 9792.9.1(e)(5), a
					 copy of all information, including correspondence, provided to the employee by
					 the claims administrator concerning the utilization review decision regarding
					 the disputed treatment.
(D) A copy
					 of any materials the employee or the employee's provider submitted to the
					 claims administrator in support of the request for the disputed medical
					 treatment.
(E) A copy of any other
					 relevant documents or information used by the claims administrator in
					 determining whether the disputed treatment should have been provided, and any
					 statements by the claims administrator explaining the reasons for the decision
					 to deny, modify, or delay the recommended treatment on the basis of medical
					 necessity.
(F) The claims
					 administrator's response to any additional issues raised in the employee's
					 application for independent medical review.
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 5.5.1 - Utilization Review Standards › Section 9792.10.6 - Independent Medical Review - Standards and Timeframes

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The independent medical review process
					 may be terminated at any time upon notice by the claims administrator to the
					 independent review organization that the disputed medical treatment has been
					 authorized.
(b)
(1) Upon assignment of the disputed medical
					 treatment for independent medical review, the independent review organization
					 shall designate a medical reviewer to conduct an examination of the documents
					 submitted pursuant to section
					 9792.10.5 and issue a
					 determination, using plain language where possible, as to whether the disputed
					 medical treatment is medically necessary. For the purpose of independent
					 medical review, "medically necessary" means medical treatment that is
					 reasonably required to cure or relieve the employee of the effects of their
					 injury and based on the standards set forth in Labor Code section
					 4610.5(c)(2).
(2) If a claims administrator fails to submit
					 the documentation required under section
					 9792.10.5(a)(1), a
					 medical reviewer may, issue a determination as to whether the disputed medical
					 treatment is medically necessary based on both a summary of medical records
					 listed in the utilization review determination issued under section
					 9792.9.1(e)(5),
					 and documents submitted by the employee or requesting physician under section
					 9792.10.5(b) or
					 (c). No independent medical review
					 determination shall issue based solely on the information provided by a
					 utilization review determination.
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 5.5.1 - Utilization Review Standards › Section 9792.10.7 - Independent Medical Review - Implementation of Determination and Appeal

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Upon receiving
					 the final determination of the Administrative Director that a disputed medical
					 treatment is medically necessary, the claims administrator shall, unless an
					 appeal is filed under subdivision (c) or liability for the treatment is
					 disputed as described in subdivision (a)(3), promptly implement the
					 determination.
(1) In the case of
					 reimbursement for services already rendered, the claims administrator shall
					 reimburse the provider or employee, whichever applies, within twenty (20) days
					 after receipt of the final determination, subject to resolution of any
					 remaining issue of the amount of payment pursuant to Labor Code sections
					 4603.2 to
					 4603.6,
					 inclusive.
(2) In the case of
					 services not yet rendered, the claims administrator shall authorize the
					 services within five (5) working days of receipt of the final determination, or
					 sooner if appropriate for the nature of the employee's medical condition, and
					 shall inform the employee and provider of the authorization.
(3) If, at the time of receiving the final
					 determination, the claims administrator is disputing liability for the medical
					 treatment on grounds other than medical necessity, implementation of the final
					 determination shall be deferred until the liability dispute has been
					 resolved.
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 5.5.1 - Utilization Review Standards › Section 9792.10.8 - Independent Medical Review - Payment for Review

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The costs of independent medical review
					 and the administration of the independent medical review system shall be borne
					 by claims administrators. For each Application for Independent Medical Review,
					 DWC Form IMR, assigned to an independent review organization for an independent
					 medical review of a disputed medical treatment, the fee for the claims
					 administrator shall be:
(1) For calendar year
					 2013:
(A) For regular review:
(i) $560.00 for each application where a
					 determination is issued under section
					 9792.10.6(b) by a
					 medical reviewer who:
(1) is a physician as
					 defined by Labor Code section
					 3209.3;
					 and
(2) holds an M.D. or D.O.
					 degree. If the review is conducted and a determination, or determinations if
					 applicable, is issued by two medical reviewers as defined in this provision,
					 the cost is $760.00
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 5.5.1 - Utilization Review Standards › Section 9792.10.9 - Independent Medical Review - Publishing of Determinations

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The Administrative Director may publish the results of
						independent medical review determinations after removing all individually
						identifiable information as defined in Labor Code section
						138.7,
						including, but not limited to, the employee, all medical providers, the claims
						administrator, any of the claims administrator's employees or contractors, or
						any utilization review organization.
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.
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 transmitted
						to OAL 12-30-2013 and filed 2-12-2014 (Register 2014, No.
						7).
Note: Authority: Sections
						  133,
						  4603.5,
						  5307.3 and
						  4610.6, Labor
						  Code. Reference: Sections
						  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 5.5.1 - Utilization Review Standards › Section 9792.13 - Assessment of Administrative Penalties - Penalty Adjustment Factors

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) In any
					 investigation that the Administrative Director deems appropriate, the
					 Administrative Director, or his or her designee, may mitigate a penalty amount
					 imposed under section
					 9792.12 after considering each of
					 these factors:
(1) The medical consequences or
					 gravity of the violation(s);
(2)
					 The good faith of the claims administrator or utilization review organization.
					 Mitigation for good faith shall be determined based on documentation of
					 attempts to comply with the Labor Code and regulations and shall result in a
					 reduction of 20% for each applicable penalty;
(3) The history of previous
					 penalties;
(4) The frequency of
					 violations found during the investigation giving rise to a penalty;
(5) Penalties may be mitigated outside the
					 above mitigation guidelines in extraordinary circumstances, when strict
					 application of the mitigation guidelines would be clearly inequitable;
					 and
(6) In the event an objection
					 or appeal is filed pursuant to subsection
					 9792.15 of these regulations,
					 whether the claims administrator or utilization review organization abated the
					 alleged violation within the time period specified by the Administrative
					 Director or his or her designee.
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 5.5.1 - Utilization Review Standards › Section 9792.14 - Liability for Penalty Assessments

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) If more than one claims administrator or
					 utilization review organization has been responsible for a claim file,
					 utilization review file or other file that is being investigated, penalties may
					 be assessed against each such entity for the violation(s) that occurred during
					 the time each such entity had responsibility for the file or for the
					 utilization review process.
(b) The
					 claims administrator or utilization review organization is liable for all
					 penalty assessments made against it, except that if the subject of the
					 investigation is acting as an agent, the agent and the principal are jointly
					 and severally liable for all penalty assessments resulting from a given
					 investigation. This paragraph does not prohibit an agent and its principal from
					 allocating the administrative penalty liability between them. Liability for
					 civil penalties assessed pursuant to Labor Code section
					 129.5(e)
					 for violations under Labor Code section
					 4610 or
					 sections 9792.6 through
					 9792.10 of Title 8 of the
					 California Code of Regulations shall not be allocated.
(c) Successor liability may be imposed on a
					 claims administrator or utilization review organization that has merged with,
					 consolidated, or otherwise continued the business of a corporation, other
					 business entity or other person that was cited by the Administrative Director
					 for violations of Labor Code section
					 4610 or
					 sections 9792.6 through
					 9792.12. The surviving entity or
					 person responsible for administering the utilization review process for an
					 employer, shall assume and be liable for all the liabilities, obligations and
					 penalties of the prior corporation or business entity. Successor liability will
					 be imposed if there has been a substantial continuity of business operations
					 and/or the new business uses the same or substantially the same work
					 force.
1. New
						section filed 6-7-2007; operative 6-7-2007 pursuant to Government Code section
						11343.4
						(Register 2007, No. 23).
Note: Authority: Sections
						  133,
						  4610 and
						  5307.3, Labor
						  Code. Reference: Sections
						  129,
						  129.5,
						  4062,
						  4600,
						  4600.4,
						  4604.5,
						  4610 and
						  4614, 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 5.5.1 - Utilization Review Standards › Section 9792.15 - Administrative Penalties Pursuant to Labor Code Sections 4610, 4610.5, and 4610.6 - Order to Show Cause, Notice of Hearing, Determination and Order, and Review Procedure

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Pursuant to Labor Code sections
					 4610(i),
					 4610.5(i),
					 and
					 4610.6(k),
					 the Administrative Director shall issue an Order to Show Cause Re: Assessment
					 of Administrative Penalty when the Administrative Director, or his or her
					 designee (the investigating unit of the Division of Workers' Compensation), has
					 reason to believe that an employer, insurer or other entity subject to Labor
					 Code sections
					 4610(i),
					 4610.5(i),
					 and
					 4610.6(k),
					 has failed to meet any of the requirements of this section or of any regulation
					 adopted by the Administrative Director pursuant to the authority of sections
					 4610(i),
					 4610.5(i), and
					 4610.6(k),
(b) The order shall be in writing and shall
					 include all of the following:
(1) Notice that
					 an administrative penalty may be assessed;
(2) For administrative penalties assessed
					 under section
					 4610(i), the final
					 investigation report, which shall consist of the notice of utilization review
					 penalty assessment, the performance rating, and may include one or more
					 requests for documentation or compliance;
(3) For administrative penalties assessed
					 under sections
					 4610.5(i) and
					 4610.6(k), the
					 basis for the penalty assessment, including a statement of the alleged
					 violations and the amount of each proposed penalty.
(4) A description of the methods for paying
					 or appealing the penalty assessment.
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 5.5.2 - Medical Treatment Utilization Schedule › Section 9792.21.1 - Medical Evidence Search Sequence

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Treating physicians and medical reviewers
					 shall conduct the following medical evidence search sequence for the evaluation
					 and treatment of injured workers.
(1) Search
					 the recommended guidelines set forth in the current MTUS to find a
					 recommendation applicable to the injured worker's medical condition or
					 injury.
(2) In the limited
					 situation where a medical condition or injury is not addressed by the MTUS or
					 if the MTUS' presumption of correctness is being challenged, then:
(A) Search the most current version of ACOEM
					 or ODG to find a recommendation applicable to the injured worker's medical
					 condition or injury. Choose the recommendation that is supported with the best
					 available evidence according to the MTUS Methodology for Evaluating Medical
					 Evidence set forth in section
					 9792.25.1. If no applicable
					 recommendation is found, or if the treating physician or reviewing physician
					 believes there is another recommendation supported by a higher quality and
					 strength of evidence, then
(B)
					 Search the most current version of other evidence-based medical treatment
					 guidelines that are recognized by the national medical community and are
					 scientifically based to find a recommendation applicable to the injured
					 worker's medical condition or injury. Choose the recommendation that is
					 supported with the best available evidence according to the MTUS Methodology
					 for Evaluating Medical Evidence set forth in section
					 9792.25.1. Medical treatment
					 guidelines can be found in the National Guideline Clearinghouse that is
					 accessible at the following website address:
www.guideline.gov/
. If no applicable
					 recommendation is found, or if the treating physician or reviewing physician
					 believes there is another recommendation supported by a higher quality and
					 strength of evidence, then
(C)
					 Search for current studies that are scientifically-based, peer-reviewed, and
					 published in journals that are nationally recognized by the medical community
					 to find a recommendation applicable to the injured worker's medical condition
					 or injury. Choose the recommendation that is supported with the best available
					 evidence according to the MTUS Methodology for Evaluating Medical Evidence set
					 forth in section
					 9792.25.1. A search for
					 peer-reviewed published studies may be conducted by accessing the U.S. National
					 Library of Medicine's database of biomedical citations and abstracts that is
					 searchable at the following website:
www.ncbi.nlm.nih.gov/pubmed
. Other
					 searchable databases may also be used.
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 5.5.2 - Medical Treatment Utilization Schedule › Section 9792.22 - General Approaches

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The Administrative Director adopts and
					 incorporates by reference into the MTUS specific guidelines set forth below
					 from the American College of Occupational and Environmental Medicine's
					 Occupational Medicine Practice Guidelines (ACOEM Practice Guidelines) for the
					 following chapters.
(1) Prevention (ACOEM May
					 1, 2011).
(2) General Approach to
					 Initial Assessment and Documentation (ACOEM July 25, 2016).
(3) Initial Approaches to Treatment (ACOEM
					 October 22, 2021).
(4) Work
					 Disability Prevention and Management (ACOEM April 11,
					 2022).
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 5.5.2 - Medical Treatment Utilization Schedule › Section 9792.23 - Clinical Topics

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 The Administrative Director adopts and incorporates by reference a series of
					 medical treatment guidelines into the MTUS commencing with section
					 9792.23.1.
(b) For all conditions or injuries not
					 addressed in the MTUS treatment guidelines, the authorized treatment and
					 diagnostic services shall be in accordance with other scientifically and
					 evidence-based medical treatment guidelines that are nationally recognized by
					 the medical community pursuant to section
					 9792.21(d)(1).
1. New
						section filed 6-15-2007; operative 6-15-2007 pursuant to Government Code
						section
						11343.4
						(Register 2007, No. 24).
2. Renumbering of former section
						9792.23 to section
						9792.26 and new section
						9792.23 filed 6-18-2009; operative
						7-18-2009 (Register 2009, No. 25).
3. Editorial correction of
						operative date in HISTORY 2 (Register 2009, No. 30).
4. Amendment of
						subsection (b) filed 4-20-2015; operative 4-20-2015 pursuant to Government Code
						section
						11343.4(b)(3)
						(Register 2015, No. 17).
5. Amendment of subsection (b)(1) filed
						7-28-2016; operative 7-28-2016 pursuant to Government Code section
						11343.4(b)(3)
						(Register 2016, No. 31).
6. Amendment filed 1-11-2018; operative
						12-1-2017. Submitted to OAL for filing and printing only pursuant to Labor Code
						section
						5307.27(a)
						(Register 2018, No. 2).
Note: Authority cited: Sections
						  133,
						  4603.5,
						  5307.3 and
						  5307.27, Labor
						  Code. Reference: Sections
						  77.5,
						  4600,
						  4604.5 and
						  5307.27, 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 5.5.2 - Medical Treatment Utilization Schedule › Section 9792.23.1 - Cervical and Thoracic Spine Disorders Guideline

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The Administrative Director adopts and incorporates by
						reference the Cervical and Thoracic Spine Disorders Guideline (ACOEM October
						17, 2018) into the MTUS from the ACOEM Practice Guidelines.
1. New
						section filed 6-18-2009; operative 7-18-2009 (Register 2009, No.
						25).
2. Editorial correction of operative date in HISTORY 1
						(Register 2009, No. 30).
3. Amendment of section heading and
						repealer and new section filed 1-11-2018; operative 12-1-2017. Submitted to OAL
						for filing and printing only pursuant to Labor Code section
						5307.27(a)
						(Register 2018, No. 2).
4. Amendment filed 4-11-2019; operative
						4-18-2019. Submitted to OAL for filing and printing only pursuant to Labor Code
						section
						5307.27(a)
						(Register 2019, No. 15).
Note: Authority cited: Sections
						  133,
						  4603.5,
						  5307.3 and
						  5307.27, Labor
						  Code. Reference: Sections
						  77.5,
						  4600,
						  4604.5 and
						  5307.27, 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 5.5.2 - Medical Treatment Utilization Schedule › Section 9792.23.2 - Shoulder Disorders Guideline

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The Administrative Director adopts and incorporates by
						reference the Shoulder Disorders Guideline (February 6, 2023) into the MTUS
						from the ACOEM Practice Guidelines.
1. New
						section filed 6-18-2009; operative 7-18-2009 (Register 2009, No.
						25).
2. Editorial correction of operative date in HISTORY 1
						(Register 2009, No. 30).
3. Amendment of section heading and
						repealer and new section filed 1-11-2018; operative 12-1-2017. Submitted to OAL
						for filing and printing only pursuant to Labor Code section
						5307.27(a)
						(Register 2018, No. 2).
4. Amendment filed 8-10-2023; operative
						8-10-2023. Submitted to OAL for filing and printing only pursuant to Labor Code
						section
						5307.27(a)
						(Register 2023, No. 32).
Note: Authority cited: Sections
						  133,
						  4603.5,
						  5307.3 and
						  5307.27, Labor
						  Code. Reference: Sections
						  77.5,
						  4600,
						  4604.5 and
						  5307.27, 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 5.5.2 - Medical Treatment Utilization Schedule › Section 9792.23.3 - Elbow Disorders Guideline

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The Administrative Director adopts and incorporates by
						reference the Elbow Disorders Guideline (ACOEM August 23, 2018) into the MTUS
						from the ACOEM Practice Guidelines.
1. New
						section filed 6-18-2009; operative 7-18-2009 (Register 2009, No.
						25).
2. Editorial correction of operative date in HISTORY 1
						(Register 2009, No. 30).
3. Amendment of section heading and
						repealer and new section filed 1-11-2018; operative 12-1-2017. Submitted to OAL
						for filing and printing only pursuant to Labor Code section
						5307.27(a)
						(Register 2018, No. 2).
4. Amendment filed 4-11-2019; operative
						4-18-2019. Submitted to OAL for filing and printing only pursuant to Labor Code
						section
						5307.27(a)
						(Register 2019, No. 15).
Note: Authority cited: Sections
						  133,
						  4603.5,
						  5307.3 and
						  5307.27, Labor
						  Code. Reference: Sections
						  77.5,
						  4600,
						  4604.5 and
						  5307.27, 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 5.5.2 - Medical Treatment Utilization Schedule › Section 9792.23.4 - Hand, Wrist, and Forearm Disorders Guideline

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The Administrative Director adopts and incorporates by
						reference the Hand, Wrist, and Forearm Disorders Guideline (ACOEM June 28,
						2023) into the MTUS from the ACOEM Practice Guidelines.
Note: Authority cited: Sections
						  133,
						  4603.5,
						  5307.3 and
						  5307.27, Labor
						  Code. Reference: Sections
						  77.5,
						  4600,
						  4604.5 and
						  5307.27, Labor
						  Code.
Note: Authority cited: Sections
						  133,
						  4603.5,
						  5307.3 and
						  5307.27, Labor
						  Code. Reference: Sections
						  77.5,
						  4600,
						  4604.5 and
						  5307.27, 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 5.5.2 - Medical Treatment Utilization Schedule › Section 9792.23.5 - Low Back Disorders Guideline

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The Administrative Director adopts and
					 incorporates by reference the Low Back Disorders Guideline (ACOEM February 13,
					 2020) into the MTUS from the ACOEM Practice Guidelines.
1. New
						section filed 6-18-2009; operative 7-18-2009 (Register 2009, No.
						25).
2. Editorial correction of operative date in HISTORY 1
						(Register 2009, No. 30).
3. Amendment of section heading and
						repealer and new section filed 1-11-2018; operative 12-1-2017. Submitted to OAL
						for filing and printing only pursuant to Labor Code section
						5307.27(a)
						(Register 2018, No. 2).
4. Amendment filed 8-28-2019; operative
						8-11-2019. Submitted to OAL for filing and printing only pursuant to Labor Code
						section
						5302.27(a)
						(Register 2019, No. 35).
5. Amendment filed 11-8-2021; operative
						11-23-2021. Submitted to OAL for filing and printing only pursuant to Labor
						Code section
						5302.27(a)
						(Register 2021, No. 46).
Note: Authority cited: Sections
						  133,
						  4603.5,
						  5307.3 and
						  5307.27, Labor
						  Code. Reference: Sections
						  77.5,
						  4600,
						  4604.5 and
						  5307.27, 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 5.5.2 - Medical Treatment Utilization Schedule › Section 9792.23.6 - Knee Disorders Guideline

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The Administrative Director adopts and incorporates by
						reference the Knee Disorders Guideline (ACOEM December 3, 2019) into the MTUS
						from the ACOEM Practice Guidelines.
1. New
						section filed 6-18-2009; operative 7-18-2009 (Register 2009, No.
						25).
2. Editorial correction of operative date in HISTORY 1
						(Register 2009, No. 30).
3. Amendment of section heading and
						repealer and new section filed 1-11-2018; operative 12-1-2017. Submitted to OAL
						for filing and printing only pursuant to Labor Code section
						5307.27(a)
						(Register 2018, No. 2).
4. Amendment filed 9-10-2020; operative
						9-21-2020. Submitted to OAL for filing and printing only pursuant to Labor Code
						section
						5307.27(a)
						(Register 2020, No. 37).
Note: Authority cited: Sections
						  133,
						  4603.5,
						  5307.3 and
						  5307.27, Labor
						  Code. Reference: Sections
						  77.5,
						  4600,
						  4604.5 and
						  5307.27, 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 5.5.2 - Medical Treatment Utilization Schedule › Section 9792.23.7 - Ankle and Foot Disorders Guideline

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The Administrative Director adopts and incorporates by
						reference the Ankle and Foot Disorders Guideline (ACOEM July 16, 2018) into the
						MTUS from the ACOEM Practice Guidelines.
1. New
						section filed 6-18-2009; operative 7-18-2009 (Register 2009, No.
						25).
2. Editorial correction of operative date in HISTORY 1
						(Register 2009, No. 30).
3. Amendment of section heading and
						repealer and new section filed 1-11-2018; operative 12-1-2017. Submitted to OAL
						for filing and printing only pursuant to Labor Code section
						5307.27(a)
						(Register 2018, No. 2).
4. Amendment filed 4-11-2019; operative
						4-18-2019. Submitted to OAL for filing and printing only pursuant to Labor Code
						section
						5307.27(a)
						(Register 2019, No. 15).
Note: Authority cited: Sections
						  133,
						  4603.5,
						  5307.3 and
						  5307.27, Labor
						  Code. Reference: Sections
						  77.5,
						  4600,
						  4604.5 and
						  5307.27, 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 5.5.2 - Medical Treatment Utilization Schedule › Section 9792.23.8 - Workplace Mental Health Guideline

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The Administrative Director adopts and
					 incorporates by reference the Introduction to the Workplace Mental Health
					 Guideline (ACOEM March 13, 2019) into the MTUS. The Workplace Mental Health
					 Guideline consists of specific modules set forth below from the ACOEM Practice
					 Guidelines addressing the issue of Workplace Mental Health:
(1) Posttraumatic Stress Disorder and Acute
					 Stress Disorder (ACOEM December 18, 2018).
(2) Depressive Disorders (ACOEM Fedruary 13,
					 2020).
(3) Anxiety Disorders (ACOEM
					 April 30, 2021).
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 5.5.2 - Medical Treatment Utilization Schedule › Section 9792.23.9 - Eye Disorders Guideline

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The Administrative Director adopts and incorporates by
						reference the Eye Disorders Guideline (ACOEM April 1, 2017) into the MTUS from
						the ACOEM Practice Guidelines.
1. New
						section filed 6-18-2009; operative 7-18-2009 (Register 2009, No.
						25).
2. Editorial correction of operative date in HISTORY 1
						(Register 2009, No. 30).
3. Amendment of section heading and
						repealer and new section filed 1-11-2018; operative 12-1-2017. Submitted to OAL
						for filing and printing only pursuant to Labor Code section
						5307.27(a)
						(Register 2018, No. 2).
Note: Authority cited: Sections
						  133,
						  4603.5,
						  5307.3 and
						  5307.27, Labor
						  Code. Reference: Sections
						  77.5,
						  4600,
						  4604.5 and
						  5307.27, 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 5.5.2 - Medical Treatment Utilization Schedule › Section 9792.23.10 - Hip and Groin Disorders Guideline

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The Administrative Director adopts and incorporates by
						reference the Hip and Groin Disorders Guideline (ACOEM April 24, 2019) into the
						MTUS from the ACOEM Practice Guidelines.
1. New
						section filed 1-11-2018; operative 12-1-2017. Submitted to OAL for filing and
						printing only pursuant to Labor Code section
						5307.27(a)
						(Register 2018, No. 2).
2. Amendment of section heading, section and
						NOTE filed 10-21-2019; operative 10-7-2019. Submitted to OAL for printing only
						pursuant to Labor Code section
						5302.27(a)
						(Register 2019, No. 43).
Note: Authority cited: Sections
						  133,
						  4603.5,
						  5307.3 and
						  5307.27, Labor
						  Code. Reference: Sections
						  77.5,
						  4600,
						  4604.5 and
						  5307.27, Labor
						  Code.