Request For Consultative Rating {DWC-AD 104 (DEU)}

DWC-AD form104 (DEU), REQUEST FOR CONSULTATIVE RATING, (a) The Disability Evaluation Unit will prepare consultative rating determinations upon request of the appeals board, workers' compensation administrative law judges, settlement conference referees, arbitrators, workers' compensation judges pro tempore and information & assistance officers. (b) Consultative rating determinations may be requested for the purpose of determining the ratable significance of factors, reviewing proposed compromise and release agreements for adequacy, determining commuted values, resolving occupational questions or any other matters within the expertise of the disability evaluators. Consultative Rating Determinations will not be admissible in judicial proceedings. (c) The Disability Evaluation Unit may also prepare consultative rating determinations upon receipt of reasonable requests from employers, injured workers or their respective representatives. A request is not considered reasonable where an insurance carrier or self-insurer seeks a consultative rating determination for the purpose of terminating its liability or for negotiating a compromise and release settlement where the injured worker has no representative. Consultative rating determinations shall not to be used as a substitute for summary rating determinations. (d) In all cases the person making a request for a consultative rating determination will provide the Disability Evaluation Unit with the occupation and age of the injured worker at the time of injury. (e) No consultative rating determination will be provided on cases in which an application for adjudication of claim has been filed with the appeals board without prior written authorization of the Appeals Board, a workers' compensation administrative law judge, settlement conference referee, arbitrator, workers' compensation judge pro tempore, or information & assistance officer. In cases where an application has been filed, the disability evaluator may require that any request for consultative rating determination be accompanied by the appeals board file. Note: Authority cited: Sections 133, 5307.3 and 5307.4, Labor Code. Reference: Sections 123.6, 123.7, 124, 5275, 5451, 5502, 5701 and 5703.5, Labor Code. (Rev. 11/2008). www.FormsWorkflow.com