“When filing a Compromise and Release or a Stipulations with Request for Award, the filing party shall file all agreed medical evaluator reports, qualified medical evaluator reports, treating physician reports, and any other [medical records] that are relevant to a determination of the adequacy… that have not been filed previously.”
(Cal. Code Regs., tit. 8, § 10700(a), as quoted in Gaines, supra, at p. 20.)
“Parties may not withhold relevant medical records and / or either intentionally or negligently misrepresent that no such medical records exist.”
(Gaines, supra, at p. 20.)
“[The civil-case inquiry] could be appropriate in circumstances where the civil case overlaps with the workers’ compensation case, giving rise to a possible third-party credit… However, the WCJ’s inquiry should be limited in scope to address the issue of adequacy and whether any third-party credit exists or may exist, and it should take place on the record.”
(Gaines, supra, at p. 22, citing Lab. Code, §§ 3850 et seq. [seeds Ch. 23].)
“We emphasize that how much information is required to support adequacy will depend on the facts of each individual case.”
(Gaines, supra, at p. 19.)
“The WCJ reviewing adequacy is considering a multitude of issues, including valuation of future medical treatment, temporary disability, permanent disability, a supplemental job displacement voucher, and death benefits. The WCJ may also consider threshold issues as to whether compensation is due, such as employment, the statute of limitations, and affirmative defenses.”
(Gaines, supra, at p. 19.)
“Parties should file supporting, relevant medicals at the time they file a settlement.”
(Gaines, supra, at p. 20.)
“[T]he parties may wish to provide a statement from applicant, witness statements, depositions, recorded video of an injury, claim benefit letters including any denial letter, or any other information that will assist the WCJ in determining adequacy.”
(Gaines, supra, at p. 20.)
“The fact that an injured worker may wish to forego litigation and settle their claim provides no information to the WCJ as to how the claim should be valued. If the parties fail to provide enough information, they should expect approval of their settlement to be delayed so that the WCJ may obtain the necessary information either through issuance of an OSA, or through a formal hearing.”
(Gaines, supra, at p. 20.)
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