Bulletin No. 28-04
June 10, 2004

Resolution of medical treatment liability Issues under Labor Code section 5402(c)

Labor Code section 5402(c) (effective April 19, 2004) requires an employer to provide necessary medical treatment after receipt of a workers' compensation claim form, but prior to accepting or denying liability for the claimed industrial injury. Such treatment must be consistent with the American College of Occupational and Environmental Medicine's (ACOEM) occupational medicine guidelines or, once adopted, the medical treatment utilization schedule to be issued by the DWC administrative director. Employer liability for the cost of treatment during the interval from filing of the claim form until acceptance or rejection of liability is limited to $10,000.

The administrative director, Division of Workers' Compensation, and chairman of the Workers' Compensation Appeals Board, issued a joint Implementation Memo on June 16, 2004 that authorizes use of the expedited hearing process to determine liability under Labor Code section 5402(c). Medical treatment is among the "issues in dispute" that entitles an applicant to request an expedited hearing under Labor Code section 5502(b). In addition, Administrative Director Rule 10136(b)(1), which implements section 5502, specifies that:

"An applicant is entitled to an expedited priority hearing and decision upon the filing of an Application for Adjudication of Claim and Request for Expedited Hearing...showing a bona fide dispute as to: (1) entitlement to medical treatment; (...)"

The issues to be resolved at expedited hearing under section 5402(c) will be limited to the following:

  1. Whether the employee filed a claim form (DWC Form 1) and the date of receipt of the claim form by the employer.
  2. Whether or not the employer accepted or rejected liability for the injury, and the date of acceptance or rejection.
  3. A general finding of whether or not medical treatment must be provided under Labor Code section 5402(c), the liability for that medical treatment, and the interval of such liability.

At an expedited hearing under Labor Code section 5402(c), the parties may request that the case be continued to a priority conference (if the employee is represented), or a status conference (if the employee is not represented) to address the issue of injury arising out of and in the course of employment.