What's Your Workers' Compensation IQ?

Now that acupuncturists are permanently considered physicians in California under the California Labor Code, more practitioners may want to consider performing workers' compensation examinations and writing reports. Currently, California acupuncturists cannot determine issues of disability and must associate with a qualified chiropractor or physician to determine such issues. Nevertheless, it is possible for acupuncturists to associate with those experts and to prepare appropriate reports for workers' compensation purposes.

Under rule 10606 of the California Labor Code, those items that must be included in workers' compensation reports are listed as follows:

A. the date of the examination;
B. the history of the injury;
C. the patient's complaints;
D. a listing of all information received from the parties reviewed in preparation of the report or relied upon for the formulation of the physician's opinion;
E. the patient's medical history, including injuries, conditions and residuals thereof, if any;
F. findings on examination;
G. a diagnosis;
H. opinion as to the nature, extent and duration of disability and work limitations, if any;
I. cause of the disability.

As a valuable resource, a copy of the Labor Code can be obtained at www.findlaw.com, an excellent website that provides links to state and national law resources. It can also be purchased from a local law bookstore.

The employee is entitled to select a physician under Labor Code 4600. The employee or physician must forthwith notify the employee of the physician's name and address, and the physician must furnish prescribed periodic reports (per Labor Code 4603.2). Thus, an employee pursuant to the labor code can predesignate a physician prior to injury. Acupuncturists may want to develop a form for their patients to predesignate them in the event of a work-related injury. If an employee does not predesignate a physician, the employer has control of medical treatment for the first 30 days after the injury; the employee can then select his/her own physician.

The following is a practice quiz on workers' compensation laws in California. Answers to the quiz can be found at the end of the article.

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Quiz Questions

1. Most states have enacted statues mandating workplace safety and compensation for workers who are injured on the job. This is known as _________ ___________.

2. Workers' compensation provides for benefits to be paid to an employee in "______-_________" injuries, which arise out of and during the course of employment.

3. Some of the benefits provided under workers' compensation laws include h______ and m_______ benefits; t_________ and p__________ disability benefits; v__________ r____________ benefits; and d_____ benefits.

4. What is the difference between an employee and an independent contractor? The key is the right to c________.

5. To be compensable, a work-related stress injury (with some exceptions) must meet the threshold of what percentage?

A. 10%
B. 20%
C. 51%
D. 90%

6. Can an employee recover in a stress claim if he or she works for less than six months (unless in case of a violent act or other exceptions)?

Yes /No

7. How long does an insurance carrier have to deny a claim for workers' compensation?

A. 10 days
B. 30 days
C. 90 days
D. 120 days

8. The employer has control of medical treatment (unless the employee predesignates a physician) for how many days after a work-related injury?

A. 10
B. 20
C. 30
D. 60

9. True or false: The doctor in question #8 can legally bill the patient for charges over and above the costs paid by the employer.

10. True or false: A client cannot fire his or her workers' compensation attorney if the client is dissatisfied with the attorney's work.

11. What is the impact of a late denial?

A. Presumption of compensability
B. Insurance carrier as a more difficult time defending the case
C. All of the above

12. Can surveillance films be taken of the injured worker by the insurance carrier?

Yes /No

13. A workers' compensation case is generally resolved in one of three ways:

A. Compromise and release
B. Stipulation and award
C. Findings and award
D. All of the above

14. True or false: If an injured worker is hurt in a car accident en route to a physician's office, the injury is considered compensable under workers' compensation law.

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Answers

1. workers' compensation.
2. work-related.
3. health and medical; temporary and permanent; vocational rehabilitation; death.
4. control. 5. 51% as of 1993. Prior to that, only 10% work-related threshold was required.
5. No. Labor Code 3208.3 requires six months.
6. 90 days.
7. C (30 days).
8. False.
9. False - a client can fire their attorney at any time.
10. C (all of the above). Since injury is presumed, the defense is left with issues of the nature and extent of injury.
11. This is often one of the most powerful tools for the defense to show an activity different than that stated by the applicant to the medical experts.
12. (all of the above). F&A refers to the findings and award by the judge, which can usually be reopened in five years. The stipulation and award occurs when parties stipulate to a level of disability and the court approves. C&R stands for compromise and release and cannot be opened. Essentially, the insurance company "buys their peace" and pays once and for all sums to conclude the case, and no future medical or other amounts of money are paid by the insurance carrier.
13. True, pursuant to the case of Laines v. WCAB (1975), 48CA3d872.