Chapter 4.5. Division of Workers' Compensation
Subchapter 1.5. Injuries on or After January 1, 1990
Article 7. Vocational Rehabilitation

§10127. Dispute Resolution.

When there is a dispute regarding the provision of vocational rehabilitation services, either the employee or claims administrator may request the Rehabilitation Unit to resolve the dispute. All requests for dispute resolution shall be submitted as follows:

(a) If the request for dispute resolution results from an employee's objection to the claims administrator's intention to withhold maintenance payment pursuant to section 4643:

(1) The employee shall forward to the Rehabilitation Unit request for Dispute Resolution DWC Form RU 103 to the correct Rehabilitation Unit district office with copy to all parties;

(2) The employee shall state his/her position with full explanation of his/her objection, and attach the same to the request for Rehabilitation Unit dispute resolution; copies shall be served on all parties;

(3) The Rehabilitation Unit shall schedule and hold a conference and issue a determination within ten (10) days of the date of receipt of the employee's objection.

(b) If a dispute exists regarding identification of a vocational goal for injuries occurring on or after 1/1/94, the parties may contact the Rehabilitation Unit for a telephone conference discussion. The Rehabilitation Unit Consultant will provide direction, issue a determination or schedule a conference to be held on an expedited basis within 10 days.

(c) Excluding (a) above, all other requests for Rehabilitation Unit dispute resolution shall be submitted by completing a Request For Dispute Resolution, DWC Form RU-103, and attaching all medical and vocational reports not previously submitted to the Rehabilitation Unit, along with a format summary of the Informal Conference. The format summary identifies the disputed issues and the positions of the parties, including supporting information which shall be attached. The request for dispute resolution and all attached documentation shall be served on the parties.

(d) Excluding (a) above, and in instances where an informal conference is either impossible or impractical:

(1) The requesting party shall:

(a) Complete the request form;

(bb) Attach all pertinent medical and vocational reports not previously submitted to the Rehabilitation Unit;

(cc) Clearly identify why an informal conference is inappropriate.

(dd) Clearly state the issue(s) and identify supporting information for each issue and position;

(ee) Serve copies on all parties.

(2) Upon receipt of the request above, the opposing party shall have twenty (20) days to forward their position with supporting information to the Rehabilitation Unit with copies to all parties.

(3) Upon receipt of all information, the Rehabilitation Unit shall either issue its determination based on the record, will ask for additional information, set the matter for formal conference, or direct the parties to meet informally.

(e) Pursuant to (b), (c) and (d) above, the Rehabilitation Unit shall issue a determination within fifty (50) days of the receipt of the original request. Where a determination denying a request issues, any further requests for dispute resolution must be accompanied with a new or updated DWC Form RU-103.

(f) When a dispute arises concerning the cost-effectiveness of providing vocational rehabilitation services outside of California, the Rehabilitation Unit may assign an Independent Vocational Evaluator (IVE) or Qualified Rehabilitation Representative (QRR), at the expense of the employer and subject to the maximum vocational rehabilitation expenditure contained in Labor Code Section 139.5, to assist the Unit in issuing a determination pursuant to Labor Code Section 4644(g).

NOTE: Authority cited: Sections 133, 139.5 and 5307.3, Labor Code. Reference: Sections 139.5, 4639, 4644 and 4645, Labor Code.

HISTORY

1. New section filed 1-18-90; operative 1-18-90 (Register 90, No. 4). New section is exempt from review by OAL pursuant to Government Code Section 11351.

2. Change without regulatory effect amending section filed 1-22-91 pursuant to section 100, title 1, California Code of Regulations (Register 91, No. 10).

3. Amendment of first paragraph and subsection (a), new subsection (b) and subsection relettering, and amendment of newly designated subsection (c), (d) and (e) filed 12-31-93; operative 1-1-94. Submitted to OAL for printing only pursuant to Government Code section 11351 (Register 93, No. 53).

4. Amendment of subsections (d)(2)-(e), new subsection (f) and amendment of Note filed 8-26-98; operative 9-25-98 (Register 98, No. 35).