Authorities as the decision cited them, with how this panel applied each one.
Labor Code
Labor Code section 4060(b)
Allows medical-legal evaluation by treating physician.
From the decision · page 9II.
Section 4060(b) allows for a medical-legal evaluation by a treating physician and section
4620(a) defines medical legal expense as "any costs and expenses...for the purpose of proving or
disproving a contested claim." Section 4064(a) provides that an employer is liable for the cost of
any comprehensive medical evaluations authorized under section 4060. The regulations provide
that the "primary treating physician shall render opinions on all medical issues necessary to
determine the employee's eligibility for compensation..." (Cal. Code Regs., tit. 8, § 9785(d).)
AD Rule 9793(h) states:
(h) "Medical-legal expense" means any costs or expenses incurred by or on behalf
of any party or parties, the administrative director, or the appeals board for X-rays,
laboratory fees, other diagnostic tests, medical reports, medical records, medical
testimony, and as needed, interpreter's fees, for the purpose of proving or
disproving a contested claim. The cost of medical evaluations, diagnostic tests, and
interpreters is not a medical-legal expense unless it is incidental to the production
of a comprehensive medical-legal evaluation report, follow-up medical-legal
evaluation report, or a supplemental medical-legal evaluation report and all of the
following conditions exist:
Labor Code
Labor Code section 4064(a)
Employer liable for cost of comprehensive medical evaluations authorized under section 4060.
From the decision · page 9II.
Section 4060(b) allows for a medical-legal evaluation by a treating physician and section
4620(a) defines medical legal expense as "any costs and expenses...for the purpose of proving or
disproving a contested claim." Section 4064(a) provides that an employer is liable for the cost of
any comprehensive medical evaluations authorized under section 4060. The regulations provide
that the "primary treating physician shall render opinions on all medical issues necessary to
determine the employee's eligibility for compensation..." (Cal. Code Regs., tit. 8, § 9785(d).)
AD Rule 9793(h) states:
(h) "Medical-legal expense" means any costs or expenses incurred by or on behalf
of any party or parties, the administrative director, or the appeals board for X-rays,
laboratory fees, other diagnostic tests, medical reports, medical records, medical
testimony, and as needed, interpreter's fees, for the purpose of proving or
disproving a contested claim. The cost of medical evaluations, diagnostic tests, and
interpreters is not a medical-legal expense unless it is incidental to the production
of a comprehensive medical-legal evaluation report, follow-up medical-legal
evaluation report, or a supplemental medical-legal evaluation report and all of the
following conditions exist:
California Code of Regulations
Cal. Code Regs., tit. 8, 9785(d)
Primary treating physician shall render opinions on all medical issues necessary to determine eligibility for compensation.
From the decision · page 9II.
Section 4060(b) allows for a medical-legal evaluation by a treating physician and section
4620(a) defines medical legal expense as "any costs and expenses...for the purpose of proving or
disproving a contested claim." Section 4064(a) provides that an employer is liable for the cost of
any comprehensive medical evaluations authorized under section 4060. The regulations provide
that the "primary treating physician shall render opinions on all medical issues necessary to
determine the employee's eligibility for compensation..." (Cal. Code Regs., tit. 8, § 9785(d).)
AD Rule 9793(h) states:
(h) "Medical-legal expense" means any costs or expenses incurred by or on behalf
of any party or parties, the administrative director, or the appeals board for X-rays,
laboratory fees, other diagnostic tests, medical reports, medical records, medical
testimony, and as needed, interpreter's fees, for the purpose of proving or
disproving a contested claim. The cost of medical evaluations, diagnostic tests, and
interpreters is not a medical-legal expense unless it is incidental to the production
of a comprehensive medical-legal evaluation report, follow-up medical-legal
evaluation report, or a supplemental medical-legal evaluation report and all of the
following conditions exist:
California Code of Regulations
Cal. Code Regs., tit. 8, 9793(h)
Defines medical-legal expense and conditions for medical-legal evaluation reports.
From the decision · page 9II.
Section 4060(b) allows for a medical-legal evaluation by a treating physician and section
4620(a) defines medical legal expense as "any costs and expenses...for the purpose of proving or
disproving a contested claim." Section 4064(a) provides that an employer is liable for the cost of
any comprehensive medical evaluations authorized under section 4060. The regulations provide
that the "primary treating physician shall render opinions on all medical issues necessary to
determine the employee's eligibility for compensation..." (Cal. Code Regs., tit. 8, § 9785(d).)
AD Rule 9793(h) states:
(h) "Medical-legal expense" means any costs or expenses incurred by or on behalf
of any party or parties, the administrative director, or the appeals board for X-rays,
laboratory fees, other diagnostic tests, medical reports, medical records, medical
testimony, and as needed, interpreter's fees, for the purpose of proving or
disproving a contested claim. The cost of medical evaluations, diagnostic tests, and
interpreters is not a medical-legal expense unless it is incidental to the production
of a comprehensive medical-legal evaluation report, follow-up medical-legal
evaluation report, or a supplemental medical-legal evaluation report and all of the
following conditions exist:
CA-WCAB
Warren Brower v. David Jones Construction (2014) 79 Cal.Comp.Cases 550 (Appeals Board en banc)
Held that injured worker is entitled to request a medical-legal report from their PTP and that the report is a medical-legal expense for which defendant is liable, even if there is an AME.
From the decision · page 10(Cal. Code Regs., tit. 8, § 9793(h).)
Read together, these sections provide that a medical-legal evaluation performed by an
employee's treating physician is a medical-legal evaluation obtained pursuant to section 4060 and
that an employer is liable for the cost of reasonable and necessary medical-legal reports that are
performed by the treating physician. The Appeals Board has previously held that there was no
legal authority to support the proposition that an injured worker is not entitled to request a medical-
legal report from their PTP, and in turn, the report from that PTP is a medical-legal expense for
which the defendant is liable. (Warren Brower v. David Jones Construction (2014) 79
Cal.Comp.Cases 550, 556 (Appeals Board en banc).)