What Is California Labor Code §4628: Medical-Legal Report Rules?

Except as provided in subdivision (c), no person, other than the physician who signs the medical-legal report, except a nurse performing those functions routinely performed by a nurse, such as taking blood pressure, shall examine the injured employee or participate in the nonclerical preparation of the report, including all of the following:

What Is Labor Code 4628?

Only your signing doctor may examine you or write the report's findings, and breaking this rule can get the report thrown out.

A medical-legal report is the medical opinion that settles a disputed question in your workers' comp claim. It might decide if your injury is work related, or how severe it is. This law protects the honesty of that report. The doctor named on the report must be the one who examined you, took your history, and wrote the conclusions. A nurse can still do routine tasks, such as taking your blood pressure, but cannot take your history or write the findings.

This law applies when you are sent for a medical-legal exam in a California workers' comp claim, including a Qualified Medical Evaluator (QME) exam or an Agreed Medical Evaluator (AME) exam. It also applies to the signing doctor and to anyone who bills for the report.

Who Can Examine You Under Labor Code 4628?

Only your signing doctor may examine you or write the report's conclusions.

The rule is narrow by design. The signing doctor, not an assistant or a trainee, must take your full history. The doctor must also review and sum up your prior records, then write the report's conclusions. A nurse can still do routine tasks, such as taking your blood pressure. A nurse cannot do your history, the record review, or the writing.

One more rule covers your records. Someone else may first outline your history or your records. Even then, the signing doctor must review all of it. The doctor must ask follow-up questions and examine you as needed. The doctor cannot simply sign off on someone else's work.

What Must a Labor Code 4628 Report Say?

The report must say when and where you were examined, confirm the signing doctor did the exam, and state whether it matched the state's timing rules.

The report must give the date and place of your exam. It must confirm the doctor who signed the report actually did it. It must also say whether the exam, and the time the doctor spent on it, matched the state's guidelines under Labor Code 139.2(j)(5) or Labor Code 5307.6. The report must name everyone who helped prepare it, other than purely clerical help, including anyone who ran a test. If the exam or the time spent did not match the guidelines, the report must explain why in detail.

This law adds two more rules. The signing doctor must sign a declaration, made under penalty of perjury, that the report is true and correct. The declaration must be dated and must name the county where it was signed. Either side can also ask the doctor for a current resume and the share of the doctor's practice time spent on treatment rather than exams.

What Can a Medical-Legal Report Bill For?

Billing is limited to the doctor's direct charges plus the fair cost of tests and paperwork.

The report can bill for the doctor's own professional work, which can include a fair share of office overhead. It can also bill the fair cost of lab work, tests, and clerical prep. It cannot bill more than that. Labor Code 4628 adds one more rule: if an outside provider ran a test, whoever bills for the report must list what that provider was actually paid. This rule does not apply to a test priced under Labor Code 5307.1.

What Happens If a Report Breaks Labor Code 4628?

A report that breaks these rules cannot be used as evidence, no one has to pay for it, and the doctor can face a fine or QME discipline.

A report that fails these rules cannot be used as evidence. A workers' comp judge will not consider it, and no one owes money for it. A knowing violation adds a civil penalty, a fine of up to $1,000 for each violation. A workers' comp judge or the Workers' Compensation Appeals Board (WCAB) decides the fine. The money goes to the Workers' Compensation Administration Revolving Fund, not to you.

• The report cannot be used to decide your claim.
• No one owes the fee for that report.
• The doctor can be fined up to $1,000 for each violation.
• A fined doctor can be suspended, put on probation, or removed as a Qualified Medical Evaluator under Labor Code 139.2.
• A knowing violation can also be treated as contempt before the WCAB.

How Does Labor Code 4628 Connect to Other Rules?

This law works with the sections that set up your exam, decide who pays, and police the doctor.

Labor Code 139.2 sets the standards for a QME, including the suspension and probation rules above. Labor Code 4062.3 controls who may contact a QME and how records reach the doctor, which overlaps with who may help write your report. Labor Code 4064 says who normally pays for a properly obtained exam. This law's rule against a bad report can override that payment rule once the report breaks these requirements. If you think your exam or report did not follow Labor Code 4628, save the report, the scheduling notice, and any letter naming who examined you, and ask your doctor or attorney to check the report against this law.

If you think your medical-legal exam or report did not follow Labor Code 4628, start by saving the report, the scheduling notice, and any letter naming who examined you. Compare those papers against the rules above. A workers' comp attorney can review whether your report meets this law and how that fits your overall claim.

Yazdchi Law reviews California workers' comp medical-legal questions from its Palmdale office. Call (661) 273-1780 or use the contact form to describe your claim. The firm reviews each matter individually before deciding whether to take it on.