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.
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.
If the appeals board determines that a treating physician's report contains opinions that are not supported by adequate evidence, they must notify the administrative director. If the administrative director finds that the physician's report contains a pattern of unsupported opinions, she must notify the physician's licensing board of such findings.
Asbestos worker is required to submit to an independent medical examination unless the appropriate authorities determine that there is adequate medical evidence that the worker developed asbestosis through work.
To be a "personal physician" of an employee, the physician must meet the following conditions: (1) be the employee's regular physician and surgeon, (2) be the employee's primary care physician, and have previously directed the medical treatment of the employee, and retain the employee's medical records, including his or her medical history; (3) agree to be predesignated.
