Labor Code 4054 and medical expense (California)

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Labor Code 4054 and medical expense (California)

Postby laesquire on Fri Apr 10, 2009 1:23 pm

SCENARIO:

1. Injury denied case.

2. Judge issues a Labor Code 4054 order barring benefits. Applicant will not go to Panel QME exams.

3. Applicant a few months later self procures a surgery.


QUESTION:
1. Is the Defense liable for medical expense ( including surgery) when a Labor 4054 order is in affect?
laesquire
 
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Re: Labor Code 4054 and medical expense (California)

Postby rosellavera on Fri Apr 10, 2009 4:56 pm

This is a tricky one. LC 4054 only bars the applicant from his right to disability payments
which accrue during the period of his failure, refusal or obstruction, to submit to the medical examination. LC 4053 suspends the applicant's right to begin or maintain any proceeding for the collection of compensation. I would argue that because applicant failed to submit to the PQME no benefits, including medical care, are warranted, as this is a denied case, and the employer is unable to determine compensability based on the applicant's unwillingness to go to a PQME.

I would object to the self-procured surgery based on the applicant's failure to comply with LC 4062.1.

-Rose
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Re: Labor Code 4054 and medical expense (California)

Postby laesquire on Sat Apr 11, 2009 8:07 pm

Good points.
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