Where this sits
- Division 1. Department of Industrial Relations
- Chapter 4.5.
- Division of Workers' Compensation
- Subchapter 1. Administrative Director -Administrative Rules
- Article 5. Predesignation of Personal Physician; Request for Change of Physician; Reporting Duties of the Primary Treating Physician; Petition for Change of Primary Treating Physician
The regulation, as printed
(a) For the purposes of this section, the following definitions apply: (1) The “primary treating physician” is the physician who is primarily responsible for managing the care of an employee, and who has examined the employee at least once for the purpose of rendering or prescribing treatment and has monitored the effect of the treatment thereafter. The primary treating physician is the physician selected by the employer, the employee pursuant to Article 2 (commencing with section 4600) of Chapter 2 of Part 2 of Division 4 of the Labor Code, or under the contract or procedures applicable to a Health Care Organization certified under section 4600.5 of the Labor Code, or in accordance with the physician selection procedures contained in the medical provider network pursuant to Labor Code section 4616. For injuries on or after January 1, 2004, a chiropractor shall not be a primary treating physician after the employee has received 24 chiropractic visits, unless the employer has authorized additional visits in writing. This prohibition shall not apply to the provision of postsurgical physical medicine prescribed by the employee's surgeon, or physician designated by the surgeon pursuant to the postsurgical component of the medical treatment utilization schedule adopted by the Administrative Director pursuant to Labor Code section 5307.27. For purposes of this subdivision, the term “chiropractic visit” means any chiropractic office visit, regardless of whether the services performed involve chiropractic manipulation or are limited to evaluation and management. (2) A “secondary physician” is any physician other than the primary treating physician who examines or provides treatment to the employee, but is not primarily responsible for continuing management of the care of the employee. For injuries on or after January 1, 2004, a chiropractor shall not be a secondary treating physician after the employee has received 24 chiropractic visits, unless the employer has authorized, in writing, additional visits. This prohibition shall not apply to the provision of postsurgical physical medicine prescribed by the employee's surgeon, or physician designated by the surgeon pursuant to the postsurgical component of the medical treatment utilization schedule adopted by the Administrative Director pursuant to Labor Code section 5307.27. For purposes of this subdivision, the term “chiropractic visit” means any chiropractic office visit, regardless of whether the services performed involve chiropractic manipulation or are limited to evaluation and management. (3) “Claims administrator” is a self-administered insurer providing security for the payment of compensation required by Divisions 4 and 4.5 of the Labor Code, a self-administered self-insured employer, or a third-party administrator for a self-insured employer, insurer, legally uninsured employer, or joint powers authority. (4) “Medical determination” means, for the purpose of this section, a decision made by the primary treating physician regarding any and all medical issues necessary to determine the employee's eligibility for compensation. Such issues include but are not limited to the scope and extent of an employee's continuing medical treatment, the decision whether to release the employee from care, the point in time at which the employee has reached permanent and stationary status, and the necessity for future medical treatment. (5) “Released from care” means a determination by the primary treating physician that the employee's condition has reached a permanent and stationary status with no need for continuing or future medical treatment. (6) “Continuing medical treatment” is occurring or presently planned treatment that is reasonably required to cure or relieve the employee from the effects of the injury. (7) “Future medical treatment” is treatment which is anticipated at some time in the future and is reasonably required to cure or relieve the employee from the effects of the injury. (8) “Permanent and stationary status” is the point when the employee has reached maximal medical improvement, meaning his or her condition is well stabilized, and unlikely to change substantially in the next year with or without medical treatment. (b)(1) An employee shall have no more than one primary treating physician at a time. (2) An employee may designate a new primary treating physician of his or her choice pursuant to Labor Code §§ 4600 or 4600.3 provided the primary treating physician has determined that there is a need for: (A) continuing medical treatment; or (B) future medical treatment. The employee may designate a new primary treating physician to render future medical treatment either prior to or at the time such treatment becomes necessary. (3) If the employee disputes a medical determination made by the primary treating physician, including a determination that the employee should be released from care, the dispute shall be resolved under the applicable procedures set forth at Labor Code sections 4060, 4061, 4062, 4600.5, 4616.3, or 4616.4. If the employee objects to a decision made pursuant to Labor Code section 4610 to modify or deny a treatment recommendation, the dispute shall be resolved by independent medical review pursuant to Labor Code section 4610.5, if applicable, or otherwise pursuant to Labor Code section 4062. (4) If the claims administrator disputes a medical determination made by the primary treating physician, the dispute shall be resolved under the applicable procedures set forth at Labor Code sections 4060, 4061, 4062, and 4610. (c) The primary treating physician, or a physician designated by the primary treating physician, shall make reports to the claims administrator as required in this section. A primary treating physician has fulfilled his or her reporting duties under this section by sending one copy of a required report to the claims administrator. A claims administrator may designate any person or entity to be the recipient of its copy of the required report. (d) The primary treating physician shall render opinions on all medical issues necessary to determine the employee's eligibility for compensation in the manner prescribed in subdivisions (e), (f), (h), (i) and (j) of this section. The primary treating physician may transmit reports to the claims administrator by encrypted electronic mail, mail, FAX, or by any other means satisfactory to the claims administrator, including electronic transmission, such as through electronic data interchange (EDI). (e)(1) Within 5 working days following initial examination, a primary treating physician, including physicians rendering first aid treatment as defined in Labor Code section 5401(a), shall submit a written report to the claims administrator on the form entitled “Doctor's First Report of Occupational Injury or Illness,” Form 5021, set forth in section 14006.1. Emergency and urgent care physicians shall also submit a Form 5021 to the claims administrator following the initial visit to the treatment facility. (2) Each new primary treating physician shall submit a Form 5021 following the initial examination in accordance with subdivision (e)(1). (3) Secondary physicians, physical therapists, and other health care providers to whom the employee is referred shall report to the primary treating physician in the manner required by the primary treating physician. (4) The primary treating physician shall be responsible for obtaining all of the reports of secondary physicians and shall, unless good cause is shown, within 20 days of receipt of each report incorporate, or comment upon, the findings and opinions of the other physicians in the primary treating physician's report and submit all of the reports to the claims administrator. (f) A primary treating physician shall, unless good cause is shown, within 20 days report to the claims administrator when any one or more of the following occurs: (1) The employee's condition undergoes a previously unexpected significant change; (2) There is any significant change in the treatment plan reported, including, but not limited to, (A) an extension of duration or frequency of treatment, (B) a new need for hospitalization or surgery, (C) a need for referral to a secondary physician for treatment or consultation, (D) a change in methods of treatment or in required physical medicine services, or (E) a need for rental or purchase of durable medical equipment or orthotic devices; (3) The employee's condition permits return to modified or regular work; (4) The employee's condition requires him or her to leave work, or requires changes in work restrictions or modifications; (5) The employee is released from care; (6) The primary treating physician concludes that the employee's permanent disability precludes, or is likely to preclude, the employee from engaging in the employee's usual occupation or the occupation in which the employee was engaged at the time of the injury; (7) The claims administrator reasonably requests appropriate additional information that is necessary to administer the claim. “Necessary” information is that which directly affects the provision of compensation benefits as defined in Labor Code Section 3207. (8) When continuing medical treatment is provided, a progress report shall be made no later than forty-five days from the last report of any type under this section even if no event described in paragraphs (1) to (7) has occurred. If an examination has occurred, the report shall be signed and transmitted within 20 days of the examination. Except for a response to a request for information made pursuant to subdivision (f)(7), reports required under this subdivision shall be submitted on the “Primary Treating Physician's Progress Report” form (Form PR-2) contained in Section 9785.2.1, or in the form of a narrative report. If a narrative report is used, it must be entitled “Primary Treating Physician's Progress Report” in bold-faced type, must indicate clearly the reason the report is being submitted, and must contain the same information using the same subject headings in the same order as Form PR-2. A response to a request for information made pursuant to subdivision (f)(7) may be made in letter format. A narrative report and a letter format response to a request for information must contain the same declaration under penalty of perjury that is set forth in the Form PR-2: “I declare under penalty of perjury that this report is true and correct to the best of my knowledge and that I have not violated Labor Code § 139.3.” By mutual agreement between the physician and the claims administrator, the physician may make reports in any manner and form. (g) Reserved. (h) As applicable in Article 5.5.1 of subchapter 1 of chapter 4.5 of title 8 of the California Code of Regulations, a written request for authorization of medical treatment for a specific course of proposed medical treatment, or a written confirmation of an oral request for a specific course of proposed medical treatment, must be made in a request for authorization in accordance with the report in subdivision (f) as applicable and as set forth in section 9792.6.1(u). A written confirmation of an oral request shall be clearly marked at the top that it is written confirmation of an oral request. The DWC Form RFA must include as an attachment documentation substantiating the need for the requested treatment. A request for authorization can be made by the primary treating physician or a secondary physician. (i) When the primary treating physician determines that the employee's condition is permanent and stationary, the physician shall, unless good cause is shown, report within 20 days from the date of examination any findings concerning the existence and extent of permanent impairment and limitations and any need for continuing and/or future medical care resulting from the injury. The information may be submitted on the “Primary Treating Physician's Permanent and Stationary Report” form (DWC Form PR-3 or DWC Form PR-4) contained in section 9785.3.1 or section 9785.4.1, or in such other manner which provides all the information required by Title 8, California Code of Regulations, section 10682. For permanent disability evaluation performed pursuant to the permanent disability evaluation schedule adopted on or after January 1, 2005, the primary treating physician's reports concerning the existence and extent of permanent impairment shall describe the impairment in accordance with the AMA Guides to the Evaluation on Permanent Impairment, 5th Edition (DWC Form PR-4). Qualified Medical Evaluators and Agreed Medical Evaluators may not use DWC Form PR-3 or DWC Form PR-4 to report medical-legal evaluations. (j) The primary treating physician, upon finding that the employee is permanent and stationary as to all conditions and that the injury has resulted in permanent partial disability, shall complete the “Physician's Return-to-Work & Voucher Report” (DWC-AD 10133.36) and attach the form to the report required under subdivision (h). (k) Any controversies concerning this section shall be resolved pursuant to Labor Code Section 4603 or 4604, whichever is appropriate. ( l ) Claims administrators shall reimburse primary treating physicians for their reports submitted pursuant to this section as required by the Official Medical Fee Schedule. Credits
The statute above this rule
Every regulation names the Labor Code it was written under. This is where the two halves of the law meet.
ImplementsLabor Code § 4061Labor Code § 4061.5Labor Code § 4062Labor Code § 4600Labor Code § 4600.3Labor Code § 4603.2Labor Code § 4604.5Labor Code § 4610.5Labor Code § 4658.7Labor Code § 4660Labor Code § 4662Labor Code § 4663Labor Code § 4664
Written under§ 4603.5
Authority and history
Note: Authority cited: Sections 133, 4603.5 and 5307.3, Labor Code. Reference: Sections 4061, 4061.5, 4062, 4600, 4600.3, 4603.2, 4604.5, 4610.5, 4658.7, 4660, 4662, 4663 and 4664, Labor Code.
1. Amendment filed 11-9-77; effective thirtieth day thereafter (Register 77, No. 46). 2. Amendment of subsection (b) filed 11-11-78; effective thirtieth day thereafter (Register 78, No. 45). 3. Amendment of subsections (c) and (d) and new subsection (e) filed 7-11-89; operative 10-1-89 (Register 89, No. 28). 4. Amendment of section and Note filed 8-31-93; operative 8-31-93. Submitted to OAL for printing only pursuant to Government Code section 11351 (Register 93, No. 36). 5. New subsection (e) and subsection relettering filed 3-27-95; operative 3-27-95. Submitted to OAL for printing only pursuant to Government Code section 11351 (Register 95, No. 13). 6. Repealer and new section filed 11-9-98; operative 1-1-99 (Register 98, No. 46). 7. Amendment of subsections (e)(1), (f)(8) and (g) filed 12-22-2000; operative 1-1-2001 pursuant to Government Code section 11343.4(d) (Register 2000, No. 51). 8. Amendment of section and Note filed 5-20-2003; operative 6-19-2003 (Register 2003, No. 21). 9. Amendment of subsections (a)(1), (a)(8), (b)(3)-(4) and (g) and amendment of Note filed 12-31-2004 as an emergency; operative 1-1-2005 (Register 2004, No. 53). A Certificate of Compliance must be transmitted to OAL by 5-2-2005 or emergency language will be repealed by operation of law on the following day. 10. Certificate of Compliance as to 12-31-2004 order, including further amendment of subsections (a)(1) and (g), transmitted to OAL 4-29-2005 and filed 6-10-2005 (Register 2005, No. 23). 11. Amendment of subsections (b)(3) and (f)(6), new subsections (g) and (i), subsection relettering and amendment of Note filed 12-31-2012 as an emergency; operative 1-1-2013 pursuant to Government Code section 11346.1(d) (Register 2013, No. 1). A Certificate of Compliance must be transmitted to OAL by 7-1-2013 or emergency language will be repealed by operation of law on the following day. 12. Amendment of subsections (b)(3) and (f)(6), new subsections (g) and (i), subsection relettering and amendment of Note refiled 7-1-2013 as an emergency; operative 7-1-2013 (Register 2013, No. 27). A Certificate of Compliance must be transmitted to OAL by 9-30-2013 or emergency language will be repealed by operation of law on the following day. 13. Amendment of subsections (b)(3) and (f)(6), new subsections (g) and (i), subsection relettering and amendment of Note refiled 9-30-2013 as an emergency; operative 10-1-2013 (Register 2013, No. 40). A Certificate of Compliance must be transmitted to OAL by 12-30-2013 or emergency language will be repealed by operation of law on the following day. 14. Certificate of Compliance as to 9-30-2013 order, including amendment of subsections (b)(3)-(4) and (g), transmitted to OAL 12-30-2013 and filed 2-12-2014; amendments effective 2-12-2014 pursuant to Government Code section 11343.4(b)(3) (Register 2014, No. 7). 15. Amendment of subsections (a)(1)-(2) filed 2-12-2014; operative 7-1-2014 pursuant to Government Code section 11343.4 (Register 2014, No. 7). 16. Amendment of subsections (e)(1)-(2), (f)(8) and (h) filed 9-21-2015; operative 10-1-2015 pursuant to Government Code section 11343.4(b)(3) (Register 2015, No. 39). 17. Amendment filed 12-30-2025; operative 4-1-2026 (Register 2026, No. 1).
What panels did with this rule
Released decisions that named § 9785, with the passage each turned on. A panel decision persuades; it does not bind.
- ADJ12308686 · 2026-06-11 · Los Angeles District Office8 CCR § 9785
Determinative passage · p.5In the present case, applicant designated Casa Colina rather than any individual physician as her primary treating physician. This designation violates AD Rule 9785(a)(1), which defines the primary treating physician as an actual physician and not a facility or other entity.
Applicant's designation of Casa Colina, a facility, as primary treating physician violates this regulation.
Official decision · page 5 → - ADJ11930717 · 2025-10-23 · Van Nuys District Office8 CCR § 9785
Determinative passage · p.2Where defendant has accepted liability for an injury, the compensability of an additional body part is ordinarily a medical determination to be made by the primary treating physician pursuant to section 4062. (See Lab. Code, § 4060(a), 4062.) In cases where applicant is being provided treatment, the ordinary procedure is to first obtain the opinion of the primary treating physician who "shall render opinions on all medical issues necessary to determine the employee's eligibility for compensation[.]" (Cal. Code Regs., tit. 8, § 9785(d).) In cases where the additional body part is outside the expertise of the primary physician, the primary physician should refer applicant to a secondary physician who "shall report to the primary physician in the manner required by the primary physician." (Id. at § 9785(e)(3).) Then, the primary physician "shall be responsible for obtaining all of the reports of the secondary physicians and...
Described the ordinary procedure for obtaining an additional panel in accepted claims and the alternative procedure in denied claims.
Official decision · page 2 → - ADJ18027061 · 2025-09-10 · Sacramento District Office8 CCR § 9785
Determinative passage · p.8We again observe, however, that following defendant's denial of all liability for applicant's claim on August 9, 2023, any medical treatment sought by applicant in response to her alleged industrial injuries would necessarily be self-procured. (Lab. Code, § 4600(a); McCoy v. Industrial Acc. Com. (1966) 64 Cal.2d 82 [31 Cal.Comp.Cases 93].) And while treatment to cure or relieve from the effects of an industrial injury is statutorily authorized under section 4600(a), a treating physician may, in the exercise of their medical judgment, declare an injured worker to be permanent and stationary. The determination is based on an assessment of whether the injured worker's "condition is well stabilized, and unlikely to change substantially in the next year with or without medical treatment." (Cal. Code Regs., tit. 8, § 9785(a)(8); § 10116.9(m); italics added.) Thus, a treating physician is authorized to determine that an injured worker has reached a permanent and stationary plateau and issue the corresponding reporting irrespective of whether medical treatment is anticipated to change applicant's condition over the following year.
The WCAB applied these standards to find the treating physicians' reports admissible despite defendant's objections, as defendant relinquished medical control after denying liability.
Official decision · page 8 → - ADJ18677760 · 2025-08-18 · Santa Ana District Office8 CCR § 9785
Determinative passage · p.2We will briefly review the relevant facts. Applicant while employed as a patrol officer by Recon Industries, Inc. dba California Safety Agency, claimed to have sustained injury arising out of and in the course of employment for the period November 30, 2022, through November 30, 2023, to shoulders, legs, back, knees, and feet. On January 1, 2024, applicant filed an Application for Adjudication (Application). On March 13, 2024, applicant's attorney designated Arbi Mirzaians, D.C., as applicant's primary treating physician (PTP) pursuant to Labor Code section 4600(c) and AD Rule 9785(b)(2) (Cal. Code Regs., tit. 8, § 9785(b)(2).) The letter requested that he prepare a medical-legal evaluation report.
Applied to the designation of Dr. Arbi Mirzaians as PTP and request for medical-legal evaluation.
Official decision · page 2 → - ADJ17343281 · 2025-04-14 · Marina del Rey District Office8 CCR § 9785
Determinative passage · p.4comply with CCR Section 9785 (a) (8), "permanent and stationary status is the point where the employee has reached maximal medical improvement, meaning his or her condition is well stabilized and unlikely to change substantially in the next year with or without medical treatment."
Defines permanent and stationary status as maximal medical improvement, relevant to termination of temporary disability benefits.
Official decision · page 4 → - ADJ9336762 · 2025-03-17 · Anaheim District Office8 CCR § 9785
Determinative passage · p.9II. Section 4060(b) allows for a medical-legal evaluation by a treating physician and section 4620(a) defines medical legal expense as "any costs and expenses...for the purpose of proving or disproving a contested claim." Section 4064(a) provides that an employer is liable for the cost of any comprehensive medical evaluations authorized under section 4060. The regulations provide that the "primary treating physician shall render opinions on all medical issues necessary to determine the employee's eligibility for compensation..." (Cal. Code Regs., tit. 8, § 9785(d).) AD Rule 9793(h) states: (h) "Medical-legal expense" means any costs or expenses incurred by or on behalf of any party or parties, the administrative director, or the appeals board for X-rays, laboratory fees, other diagnostic tests, medical reports, medical records, medical testimony, and as needed, interpreter's fees, for the purpose of proving or disproving a contested claim. The cost of medical evaluations, diagnostic tests, and interpreters is not a medical-legal expense unless it is incidental to the production of a comprehensive medical-legal evaluation report, follow-up medical-legal evaluation report, or a supplemental medical-legal evaluation report and all of the following conditions exist:
Primary treating physician shall render opinions on all medical issues necessary to determine eligibility for compensation.
Official decision · page 9 → - ADJ17166141 · 2025-01-06 · Santa Ana District Office8 CCR § 9785
Determinative passage · p.10II. Section 4060(b) allows for a medical-legal evaluation by a treating physician and section 4620(a) defines medical legal expense as "any costs and expenses...for the purpose of proving or disproving a contested claim." Section 4064(a) provides that an employer is liable for the cost of any comprehensive medical evaluations authorized under section 4060. The regulations provide that the "primary treating physician shall render opinions on all medical issues necessary to determine the employee's eligibility for compensation..." (Cal. Code Regs., tit. 8, § 9785(d).) AD Rule 9793(h) states: (h) "Medical-legal expense" means any costs or expenses incurred by or on behalf of any party or parties, the administrative director, or the appeals board for X-rays, laboratory fees, other diagnostic tests, medical reports, medical records, medical testimony, and as needed, interpreter's fees, for the purpose of proving or disproving a contested claim. The cost of medical evaluations, diagnostic tests, and interpreters is not a medical-legal expense unless it is incidental to the production of a comprehensive medical-legal evaluation report, follow-up medical-legal evaluation report, or a supplemental medical-legal evaluation report and all of the following conditions exist:
The Board applied these statutes and regulations to determine that a medical-legal evaluation by a PTP is a medical-legal expense for which the employer is liable if reasonable and necessary.
Official decision · page 10 → - ADJ16961549 · 2024-09-16 · Van Nuys District Office8 CCR § 9785
Determinative passage · p.6Maximum medical improvement/permanent and stationary status is defined as the "point when the employee has reached maximum medical improvement, meaning his or her condition is well stabilized, and unlikely to change substantially in the next year with or without medical treatment." CCR section 9785(a)(8). In this case, we have the 20-20 vision of hindsight as in the nearly one year since the PQME has evaluated the applicant has not had any substantial change to merit TTD/TPD benefits. No surgery has been requested or scheduled. Second, applicant has attended medical appointments on a sporadic and meandering basis with various doctors none of whom identify themselves as the PTP in this case. Third, not one of the medicals has ever placed the applicant on TTD. Only one report from a spine consult places the applicant on temporary partial disability and defers to the PTP whose identity is unknown. In addition, that report stated that a narrative would follow and it did not.
Defines maximum medical improvement/permanent and stationary status as the point when the condition is well stabilized and unlikely to change substantially in the next year.
Official decision · page 6 →
Rules beside this one
Article 5. Predesignation of Personal Physician; Request for Change of Physician; Reporting Duties of the Primary Treating Physician; Petition for Change of Primary Treating Physician — regulations rarely stand alone, and the answer is often two sections away.
- § 9780.2Employer's Duty to Provide First Aid and Emergency Treatment
- § 9781Employee's Request for Change of Physician.1 decisions
- § 9782Notice to Employee of Right to Choose Physician.1 decisions
- § 9783DWC Form 9783 Predesignation of Personal Physician.
- § 9784Duties of the Employer.
- § 9785.5Request for Authorization Form, DWC Form RFA .