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§ 3306(b)-1. Independent Medical Examination.

22 CA ADC § 3306(b)-1Barclays Official California Code of Regulations

Barclays California Code of Regulations
Title 22. Social Security
Division 1. Employment Development Department (Refs & Annos)
Subdivision 1. Director of Employment Development (Refs & Annos)
Division 1. Unemployment and Disability Compensation
Part 2. Disability Compensation
Chapter 7. Family Temporary Disability Insurance
22 CCR § 3306(b)-1
§ 3306(b)-1. Independent Medical Examination.
Currentness
(a) The Department may request an independent medical examination to determine its liability for the payment of Family Temporary Disability Insurance benefits to a claimant. Any care recipient, except one who depends for healing entirely upon prayer or spiritual means, as provided in Section 2709 of the code, may be required to submit to independent medical examinations when one or more of the following circumstances is present:
(1) Medical information received from the care recipient's physician does not verify the serious health condition, the need for care, or provide any objective medical findings that support that the claimant's participation is warranted for the period of time claimed.
(2) Inconsistent information is received concerning the care recipient's serious health condition or the need for the claimant's care.
(b) Independent medical examinations requested by the director must meet all of the following conditions:
(1) The examining physician must provide an independent and impartial opinion. If the claimant or care recipient requests a different examining physician, the examination will be rescheduled with another physician designated by the director.
(2) The examination and any laboratory or x-ray procedures will be only extensive enough to determine whether the care recipient has a serious health condition, whether the claimant's participation is warranted, and the period of time that the claimant's participation is warranted. The examination is an evaluation and not a consultation.
(3) The fee for the examination and any laboratory or X-ray procedures will be paid by the department in accordance with a fee schedule determined by the director.
(c) A claimant who receives a request for the care recipient to submit to an independent medical examination must contact the designated physician not later than the seventh consecutive day after the date the request was mailed to the claimant to arrange an examination for the care recipient on the earliest date available. Such time will be extended by the department upon a showing of good cause. The request for an independent medical examination will be cancelled if, within the 7-day period, the claimant reports that he or she returned to work or that his or her care is no longer warranted.
(d) The claimant is subject to disqualification if:
(1) He or she fails to contact the designated physician within the time in subdivision (c). The claimant is disqualified on the eighth day after the date the request was mailed to the claimant.
(2) He or she makes an appointment but the care recipient fails to report for the examination, or cancels the appointment. The claimant is disqualified commencing on the date of the appointment, or the date of the cancellation, whichever is earlier.
(3) The claimant or care recipient fails to comply with the request for an independent medical examination but later agrees to submit to one. The disqualification ends the day before the examination date.
(e) Upon receipt of the independent medical examination report, the department determines a claimant's eligibility as follows:
(1) If the report confirms or extends the estimated duration of the care recipient's serious health condition and the need for care as certified by the care recipient's physician, the claimant is eligible for benefits.
(2) If the report states that the need for the claimant's care will end earlier than the date given by the care recipient's physician, the claimant is eligible for benefits through the date in the report.
(3) If the report states that the care recipient does not have a serious health condition or that the claimant's care is not warranted, the claimant is disqualified commencing on the examination date.

Credits

Note: Authority cited: Sections 305 and 306, Unemployment Insurance Code. Reference: Sections 2709 and 3306, Unemployment Insurance Code.
History
1. New section filed 6-23-2004; operative 7-1-2004 pursuant to Government Code section 11343.4 (Register 2004, No. 26).
This database is current through 6/14/24 Register 2024, No. 24.
Cal. Admin. Code tit. 22, § 3306(b)-1, 22 CA ADC § 3306(b)-1
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