5300.  All the following proceedings shall be instituted before the
appeals board and not elsewhere, except as otherwise provided in
Division 4:
   (a) For the recovery of compensation, or concerning any right or
liability arising out of or incidental thereto.
   (b) For the enforcement against the employer or an insurer of any
liability for compensation imposed upon  the employer by this
division in favor of the injured employee, his or her dependents, or
any third person.
   (c) For the determination of any question as to the distribution
of compensation among dependents or other persons.
   (d) For the determination of any question as to who are dependents
of any deceased employee, or what persons are entitled to any
benefit under the compensation provisions of this division.
   (e) For obtaining any order which by Division 4 the appeals board
is authorized to make.
   (f) For the determination of any other matter, jurisdiction over
which is vested by Division 4 in the Division of  Workers'
Compensation, including the administrative director and the appeals
board.


5301.  The appeals board is vested with full power, authority and
jurisdiction to try and determine finally all the matters specified
in Section 5300 subject only to the review by the courts as specified
in this division.


5302.  All orders, rules, findings, decisions, and awards of the
appeals board shall be prima facie lawful and conclusively presumed
to be reasonable and lawful, until and unless they are modified or
set aside by the appeals board or upon a review by the courts within
the time and in the manner specified in this division.




5303.  There is but one cause of action for each injury coming
within the provisions of this division.  All claims brought for
medical expense, disability payments, death benefits, burial expense,
liens, or any other matter arising out of such injury may, in the
discretion of the appeals board, be joined in the same proceeding at
any time; provided, however, that no injury, whether specific or
cumulative, shall, for any purpose whatsoever, merge into or form a
part of another injury; nor shall any award based on a cumulative
injury include disability caused by any specific injury or by any
other cumulative injury causing or contributing to the existing
disability, need for medical treatment or death.



5304.  The appeals board has jurisdiction over any controversy
relating to or arising out of Sections 4600 to 4605 inclusive, unless
an express agreement fixing the amounts to be paid for medical,
surgical or hospital treatment as such treatment is described in
those sections has been made between the persons or institutions
rendering such treatment and the employer or insurer.



5305.  The Division of  Workers' Compensation, including the
administrative director, and the appeals board have jurisdiction over
all controversies arising out of injuries suffered  outside the
territorial limits of this state in those cases where the injured
employee is a resident of this state at the time of the injury and
the contract of hire was made in this state.  Any employee described
by this section, or his or her dependents, shall be entitled to the
compensation or death benefits provided by this division.



5306.  The death of an employer subsequent to the sustaining of an
injury by an employee shall not impair the right of the employee to
proceed before the appeals board against the estate of the employer,
and the failure of the employee or his dependents to cause the claim
to be presented to the executor or administrator of the estate shall
not in any way bar or suspend such right.



5307.  (a) Except for those rules and regulations within the
authority of the court administrator regarding trial level
proceedings as defined in subdivision (c), the appeals board may by
an order signed by four members:
   (1) Adopt reasonable and proper rules of practice and procedure.
   (2) Regulate and provide the manner in which, and by whom, minors
and incompetent persons are to appear and be represented before it.
   (3) Regulate and prescribe the kind and character of notices,
where not specifically prescribed by this division, and the service
thereof.
   (4) Regulate and prescribe the nature and extent of the proofs and
evidence.
   (b) No rule or regulation of the appeals board pursuant to this
section shall be adopted, amended, or rescinded without public
hearings.  Any written request filed with the appeals board seeking a
change in its rules or regulations shall be deemed to be denied if
not set by the appeals board for public hearing to be held within six
months of the date on which the request is received by the appeals
board.
   (c) The court administrator shall adopt reasonable, proper, and
uniform rules for district office procedure regarding trial level
proceedings of the workers' compensation appeals board.  These rules
shall include, but not be limited to, all of the following:
   (1) Rules regarding conferences, hearings, continuances, and other
matters deemed reasonable and necessary to expeditiously resolve
disputes.
   (2) The kind and character of forms to be used at all trial level
proceedings.
   All rules and regulations adopted by the court administrator
pursuant to this subdivision shall be subject to the requirements of
the rulemaking provisions of the Administrative Procedure Act
(Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code).



5307.1.  (a) (1) The administrative director, after public hearings,
shall adopt and revise, no less frequently than biennially, an
official medical fee schedule which shall establish reasonable
maximum fees paid for medical services provided pursuant to this
division.  No later than January 1, 1995, the administrative director
shall have revised the schedule.  By no later than January 1, 1995,
the schedule shall include services for health care facilities
licensed pursuant to Section 1250 of the Health and Safety Code, and
drugs and pharmacy services.  The fee schedule for health care
facilities shall take into consideration cost and service
differentials for various types of facilities.
   (2) The administrative director shall include services provided by
physical therapists, physician assistants, and nurse practitioners
in the official fee schedule adopted and revised pursuant to
paragraph (1).  Nothing in this paragraph shall affect the ability of
physicians to continue to be reimbursed for their services in
accordance with the official medical fee schedule adopted pursuant to
paragraph (1) for the provision of services within their scope of
practice.
   (3) The administrative director shall consult with statewide
professional organizations representing affected providers on the
update of the official medical fee schedule.
   (b) Nothing in this section shall prohibit a medical provider or a
licensed health care facility from being paid by an employer or
carrier fees in excess of those set forth on the official medical fee
schedule, provided that the fee is:
   (1) Reasonable.
   (2) Accompanied by itemization and justified by an explanation of
extraordinary circumstances related to the unusual nature of the
medical services rendered.
   In no event shall a physician charge in excess of his or her usual
fee.
   (c) In the event of a dispute between the physician and the
employer or carrier concerning the medical fees charged, the
physician may be allowed a reasonable fee for testimony, if a
physician testifies pursuant to the employer's or carrier's subpoena,
and the referee determines that the medical fee charged was
reasonable.
   (d) Except as provided in Section 4626, the official medical fee
schedule shall not apply to medical-legal expenses as defined by
Section 4620.



5307.11.  A health care provider or health facility licensed
pursuant to Section 1250 of the Health and Safety Code, and a
contracting agent, employer, or carrier may contract for
reimbursement rates different from those in the fee schedule adopted
and revised pursuant to Section 5307.1.  When a health care provider
or health facility licensed pursuant to Section 1250 of the Health
and Safety Code, and a contracting agent, employer, or carrier
contract for reimbursement rates different from those in the fee
schedule, the medical fee schedule for that health care provider or
health facility licensed pursuant to Section 1250 of the Health and
Safety Code shall not apply to the contracted reimbursement rates.
Except as provided in subdivision (b) of Section 5307.1, the official
medical fee schedule shall establish maximum reimbursement rates for
all medical services for injuries subject to this division provided
by a health care provider or health care facility licensed pursuant
to Section 1250 of the Health and Safety Code other than those
specified in contracts subject to this section.



5307.2.  The administrative director, after public hearings, shall
adopt, not later than July 1, 2003, and revise, no less frequently
than biennially, an official pharmaceutical fee schedule that shall
establish reasonable maximum fees paid for medicines and medical
supplies provided pursuant to this division.  This schedule shall be
included within the official medical fee schedule adopted by the
administrative director pursuant to Section 5307.1.  In adopting the
reasonable maximum fees included within the official pharmaceutical
fee schedule, the administrative director may consult any relevant
studies or practices in other states or in other payment systems in
California.  The schedule shall include a single dispensing fee.  The
schedule shall provide for access to a pharmacy within a reasonable
geographic distance from an injured employee's residence.



5307.21.  (a) The administrative director shall have the sole
authority to develop an outpatient surgery facility fee schedule for
services not performed under contract, provided that the schedule
meets all of the following requirements:
   (1) The schedule shall include all facility charges for outpatient
surgeries performed in any facility authorized by law to perform the
surgeries.  The schedule may not include the fee of any physician
and surgeon providing services in connection with the surgery.
   (2) The schedule shall promote payment predictability, minimize
administrative costs, and ensure access to outpatient surgery
services by insured workers.
   (3) The schedule shall be sufficient to cover the costs of each
surgical procedure, as well as access to quality care.
   (4) The schedule shall include specific provisions for review and
revision of related fees no less frequently then biennially.
   (5) The schedule shall be adopted after public hearings pursuant
to Section 5307.3 and shall be included within the official medical
fee schedule.
   (b) The process used by the administrative director to develop an
outpatient surgery fee schedule shall contain the following elements:

   (1) A formal analysis of one year of published data collected
pursuant to Section 128737 of the Health and Safety Code, with the
assistance of an independent consultant with demonstrated expertise
in outpatient surgery service.
   (2) Any published data collected from providers of outpatient
surgery services.
   (3) Payment data including, but not limited to, type of payer and
amount charged.
   (4) Cost data including, but not limited to, actual expenses for
labor, supplies, equipment, implants, anesthesia, overhead, and
administration.
   (5) Outcome data including, but not limited to, expected level of
rehabilitation, expected coverage timeframe, and incidence of
infection.
   (6) Access data including, but not limited to, date of injury,
date of surgery recommendation, and data of procedure.
   (7) Other data that is mutually agreed to by the Office of
Statewide Health Planning and Development and the administrative
director.  The administrative director shall consult with the Office
of Statewide Health Planning and Development to ensure that the data
collected is comprehensive and relevant to the development of a fee
schedule.
   (c) The outpatient surgery facility fee schedule shall reflect
input from workers' compensation insurance carriers, businesses,
organized labor, providers of outpatient surgical services, and
patients receiving outpatient surgical services.



5307.21.  (a) The administrative director shall have the sole
authority to develop an outpatient surgery facility fee schedule for
services not performed under contract, provided that the schedule
meets all of the following requirements:
   (1) The schedule shall include all facility charges for outpatient
surgeries performed in any facility authorized by law to perform the
surgeries.  The schedule may not include the fee of any physician
and surgeon providing services in connection with the surgery.
   (2) The schedule shall promote payment predictability, minimize
administrative costs, and ensure access to outpatient surgery
services by injured workers.
   (3) The schedule shall be sufficient to cover the costs of each
surgical procedure, as well as access to quality care.
   (4) The schedule shall include specific provisions for review and
revision of related fees no less frequently than biennially.
   (5) The schedule shall be adopted after public hearings pursuant
to Section 5307.3 and shall be included within the official medical
fee schedule.
   (b) The process used by the administrative director to develop an
outpatient surgery fee schedule shall contain the following elements:

   (1) A formal analysis of one year of published data collected
pursuant to Section 128737 of the Health and Safety Code, with the
assistance of an independent consultant with demonstrated expertise
in outpatient surgery service.
   (2) Any published data collected from providers of outpatient
surgery services.
   (3) Payment data including, but not limited to, type of payer and
amount charged.
   (4) Cost data including, but not limited to, actual expenses for
labor, supplies, equipment, implants, anesthesia, overhead, and
administration.
   (5) Outcome data including, but not limited to, expected level of
rehabilitation, expected coverage timeframe, and incidence of
infection.
   (6) Access data including, but not limited to, date of injury,
date of surgery recommendation, and date of procedure.
   (7) Other data that is mutually agreed to by the Office of
Statewide Health Planning and Development and the administrative
director.  The administrative director shall consult with the Office
of Statewide Health Planning and Development to ensure that the data
collected is comprehensive and relevant to the development of a fee
schedule.
   (c) The outpatient surgery facility fee schedule shall reflect
input from workers' compensation insurance carriers, businesses,
organized labor, providers of outpatient surgical services, and
patients receiving outpatient surgical services.
   (d) At least 90 days prior to commencing the public hearings
related to an outpatient surgery fee schedule as prescribed by
Section 5307.3, the administrative director shall provide the
Assembly Committee on Insurance and the Senate Committee on Labor and
Industrial Relations a comprehensive report on the data analysis
required by this section and the administrative director's
recommendations for an outpatient surgery fee schedule.



5307.3.  The administrative director may adopt, amend, or repeal any
rules and regulations that are reasonably necessary to enforce this
division, except where this power is specifically reserved to the
appeals board or the Industrial Medical Council.
   No rule or regulation of the administrative director pursuant to
this section shall be adopted, amended, or rescinded without public
hearings.  Any written request filed with the administrative director
seeking a change in its rules or regulations shall be deemed to be
denied if not set by the administrative director for public hearing
to be held within six months of the date on which the request is
received by the administrative director.



5307.4.  (a) Public hearings required under Sections 5307 and 5307.3
shall be subject to the provisions of this section except to the
extent that there is involved a matter relating to the management, or
to personnel, or to public property, loans, grants, benefits, or to
contracts, of the appeals board or the administrative director.
   (b) Notice of the rule or regulation proposed to be adopted,
amended, or rescinded, shall be given to such business and labor
organizations and firms or individuals who have requested notice
thereof.  The notice shall include all of the following:
   (1) A statement of the time, place, and nature of the public
hearings.
   (2) Reference to the legal authority under which the rule is
proposed.
   (3) Either the terms or substance of the proposed rule, or a
description of the subjects and the issues involved.
   (c) Except where the proposed rule or regulation has a significant
impact on the public, this section shall not apply to interpretive
rules, general statements of policy, or rules of agency organization.

   (d) After notice required by this section, the appeals board or
the administrative director shall give interested persons the
opportunity to participate in the rulemaking through submission of
written data, views, or arguments, with opportunity for oral
presentation.  If, after consideration of the relevant matter
presented, the appeals board or the administrative director adopts a
rule, it or he shall publish a concise, general statement of reasons
for the adoption of the rule. The rule and statement of reasons shall
be given to the same individuals and organizations who have
requested notice of hearings.
   (e) The notice required under this section shall be made not less
than 30 days prior to the public hearing date.



5307.5.  The appeals board or a workers' compensation judge may:
   (a) Appoint a trustee or guardian ad litem to appear for and
represent any minor or incompetent upon the terms and conditions
which it deems proper.  The guardian or trustee shall, if required by
the appeals board, give a bond in the form and of the character
required by law from a guardian appointed by a superior court and in
the amount which the appeals board determines.  The bond shall be
approved by the appeals board, and the guardian or trustee shall not
be discharged from liability until he or she files an account with
the appeals board or with the superior court and the account is
approved.  The trustee or guardian shall receive the compensation for
his or her services fixed and allowed by the appeals board or by the
superior court.
   (b) Provide for the joinder in the same proceeding of all persons
interested therein, whether as employer, insurer, employee,
dependent, creditor, or otherwise.



5307.6.  (a) The administrative director shall adopt and revise a
fee schedule for medical-legal expenses as defined by Section 4620,
which shall be prima facie evidence of the reasonableness of fees
charged for medical-legal expenses at the same time he or she adopts
and revises the medical fee schedule pursuant to Section 5307.1.
   The schedule shall consist of a series of procedure codes,
relative values, and a conversion factor producing fees which provide
remuneration to physicians performing medical-legal evaluations at a
level equivalent to that provided to physicians for reasonably
comparable work, and which additionally recognizes the relative
complexity of various types of evaluations, the amount of time spent
by the physician in direct contact with the patient, and the need to
prepare a written report.
   (b) A provider shall not be paid fees in excess of those set forth
in the fee schedule established under this section unless the
provider provides an itemization and explanation of the fee that
shows that it is both a reasonable fee and that extraordinary
circumstances relating to the medical condition being evaluated
justify a higher fee; provided, however, that in no event shall a
provider charge in excess of his or her usual fee.  The employer and
employee shall have standing to contest fees in excess of those set
forth in the fee schedule.
   (c) In the event of a dispute between the provider and the
employer, employee, or carrier concerning the fees charged, the
provider may be allowed a reasonable fee for testimony if the
provider testified pursuant to the employer's or carrier's subpoena
and the judge or referee determines that the fee charged was
reasonable and justified by extraordinary circumstances.
   (d) (1) No provider may request nor accept any compensation,
including, but not limited to, any kind of remuneration, discount,
rebate, refund, dividend, distribution, subsidy, or other form of
direct or indirect payment, whether in money or otherwise, from any
source for medical-legal expenses if such compensation is in addition
to the fees authorized by this section.  In addition to being
subject to discipline pursuant to the provisions of subdivision (k)
of Section 139.2, any provider violating this subdivision is subject
to disciplinary action by the appropriate licensing board.
   (2) This subdivision does not apply to medical-legal expenses for
which the administrative director has not adopted a fee schedule.




5308.  The appeals board has jurisdiction to determine controversies
arising out of insurance policies issued to self-employing persons,
conferring benefits identical with those prescribed by this division.

   The appeals board may try and determine matters referred to it by
the parties under the provisions of Title 9 (commencing with Section
1280) of Part 3 of the Code of Civil Procedure, with respect to
controversies arising out of insurance issued to self-employing
persons under the provisions of this division.  Such controversies
may be submitted to it by the signed agreement of the parties, or by
the application of one party and the submission of the other to its
jurisdiction, with or without an express request for arbitration.
   The State Compensation Insurance Fund, when the consent of the
other party is obtained, shall submit to the appeals board all
controversies susceptible of being arbitrated under this section.
   In acting as arbitrator under this section, the appeals board has
all the powers which it may lawfully exercise in compensation cases,
and its findings and award upon such arbitration have the same
conclusiveness and are subject to the same mode of reopening, review,
and enforcement as in compensation cases. No fee or cost shall be
charged by the appeals board for arbitrating  the issues presented
under this section.



5309.  The appeals board may, in accordance with rules of practice
and procedure which it shall adopt and upon the agreement of the
parties, on the application of either, or of its own motion, and with
or without notice, direct and order  a workers' compensation judge:

   (a) To try the issues in any proceeding before it, whether of fact
or of law, and make and file a finding, order, decision, or award
based thereon.
   (b) To hold hearings and ascertain facts necessary to enable the
appeals board to determine any proceeding or to make any order,
decision, or award that the appeals board is authorized to make under
Divisions 4 or 5, or necessary for the information of the appeals
board.
   (c) To issue writs or summons, warrants of attachment, warrants of
commitment, and all necessary process in proceedings for direct and
hybrid contempt in a like manner and to the same extent as courts of
record.  For the purposes of this section, "hybrid contempt" means a
charge of contempt which arises from events occurring in the
immediate presence of the workers' compensation judge for reasons
which occur outside the presence of the workers' compensation judge.



5310.  The appeals board may appoint one or more workers'
compensation administrative law judges in any proceeding, as it may
deem necessary or advisable, and may refer, remove to itself, or
transfer to a workers' compensation administrative law judge the
proceedings on any claim.  The administrative director, after
consideration of the recommendation of the court administrator, may
appoint workers' compensation administrative law judges.  Any workers'
compensation administrative law judge appointed by the
administrative director has the powers, jurisdiction, and authority
granted by law, by the order of appointment, and by the rules of the
appeals board.



5311.  Any party to the proceeding may object to the reference of
the proceeding to a particular workers' compensation judge upon any
one or more of the grounds specified in Section 641 of the Code of
Civil Procedure and the objection shall be heard and disposed of by
the appeals board.  Affidavits may be read and witnesses examined as
to the objections.



5311.5.  The administrative director or the court administrator
shall require all workers' compensation administrative law judges to
participate in continuing education to further their abilities as
workers' compensation administrative law judges, including courses in
ethics and conflict of interest.  The director may coordinate the
requirements with those imposed upon attorneys by the State Bar in
order that the requirements may be consistent.



5312.  Before entering upon his or her duties, the workers'
compensation judge shall be sworn, before an officer authorized to
administer oaths, faithfully and fairly to hear and determine the
matters and issues referred to him or her, to make just findings and
to report according to his or her understanding.



5313.  The appeals board or the workers' compensation judge shall,
within 30 days after the case is submitted, make and file findings
upon all facts involved in the controversy and an award, order, or
decision stating the determination as to the rights of the parties.
Together with the findings, decision, order or award there shall be
served upon all the parties to the proceedings a summary of the
evidence received and relied upon and the reasons or grounds upon
which the determination was made.



5315.  Within 60 days after the filing of the findings, decision,
order or award, the appeals board may confirm, adopt, modify or set
aside the findings, order, decision, or award of a workers'
compensation judge and may, with or without further proceedings, and
with or without notice, enter its order, findings, decision, or award
based upon the record in the case.



5316.  Any notice, order, or decision required by this division to
be served upon any person either before, during, or after the
institution of any proceeding before the appeals board, may be served
in the manner provided by Chapter 5, Title 14 of Part 2 of the Code
of Civil Procedure, unless otherwise directed by the appeals board.
In the latter event the document shall be served in accordance with
the order or direction of the appeals board.  The appeals board may,
in the cases mentioned in the Code of Civil Procedure, order service
to be made by publication of notice of time and place of hearing.
Where service is ordered to be made by publication the date of the
hearing may be fixed at more than 30 days from the date of filing the
application.



5317.  Any such notice, order or decision affecting the State or any
county, city, school district, or public corporation therein, shall
be served upon the person upon whom the service of similar notices,
orders, or decisions is authorized by law.



5318.  Notwithstanding any other provision of law, the termination
date of December 31, 2001, provided in Section 9792.1 of Title 8 of
the California Code of Regulations shall be extended until the
effective date of new regulations adopted by the administrative
director, as required by Section 5307.1, providing for the biennial
review of the fee schedule for health care facilities.

If You Need to Retain and Pay a California Attorney Regarding This Issue:

Brian Kindsvater, Esq.
Law Office of Brian Kindsvater
2377 Gold Meadow Way, #1031
Gold River, CA 95670
email
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Mr. Kindsvater has assisted numerous individuals and businesses throughout California and the United States regarding California employment, business, and other legal issues.