Labor Code

The administrative director shall conduct a study of the medical treatment provided for industrial injuries and illnesses. In conducting the study the administrator shall keep all patient identifying information confidential.

Reports shall not identify particular claims file; contents of individual claim files and auditor's working papers shall be confidential. Disclosure of claim information to the administrative director pursuant to an audit shall not waive the provisions of the Evidence Code relating to privilege.

Persons or entities that are not a party to a workers' compensation benefits claim may not obtain individually identifiable information pertaining to the claim from the Division of Workers' Compensation, except as provided.

Insurers shall discuss all factors affecting the employer's premium with the employer. Insurers may not discuss medical information as defined in Civil Code 56.05 obtained from about an employee who has filed a worker's compensation claim except for the following: (1) medical information regarding the diagnosis of the condition for which compensation is claimed and the treatment provided, (2) medical information about the injury claim that is necessary for the employer to have to modify employee work duties.

Physician conducting examinations pursuant to 4050, may be required to report or testify as to the results of the examination.

Party may subpoena medical records in any proceeding under this division. Person in possession of the records must be served and a copy of the subpoena must be sent to all parties in the proceeding.

Employee requesting compensation for permanent disability that may be payable, but the injury is not yet permanent or stable may be monitored until it is permanent. At which time, the employee will be evaluated to determine the extent of permanent disability and the need for continuing medical care, or the employer will disclose the amount payable for the disability.

Either the employee or the employer may object to the medical determination made by the treating physician provided that the medical issue does not fall within the exceptions from objections. If the employee objects to the utilization review decision to modify, delay , or deny the recommended treatment, the employee must notify the employer. If the employer has an attorney a medical evaluation must be obtained as provided and no other medical evaluation may be obtained.

The employer may object to the recommendation for spinal surgery made by the treating physician. If the employee has an attorney, the parties must agree on an orthopedic surgeon or neurosurgeon to prepare a second opinion to resolve the dispute. If an agreement is not reached or the employee does not have an attorney, the administrative director must randomly select an orthopedic surgeon or orthopedic surgeon to prepare a second opinion to resolve the dispute.

In order to determine medical issues in regards to workers' compensation, the parties may submit the following to an agreed upon medical evaluator: records from the treating physicians), medical records relevant to determining the medical issue. The medical evaluator must prepare a report and indicate all information received, all information reviewed for the report, and all information relied upon in forming her opinion.