California Code of Regulations
Title 8 - Industrial Relations
Division 1 - Department of Industrial Relations
Chapter 7 - Department of Industrial Relations
Subchapter 1 - Occupational Injury or Illness Reports and Records
Article 1 - Reporting of Occupational Injury or Illness
Section 14003 - Physician
Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a) Every physician, as defined in Labor Code Section 3209.3, who attends an injured employee shall file, within five days after initial examination, a complete report of every occupational injury or occupational illness to such employee, with the employer's insurer, or with the employer, if self-insured. The injured or ill employee, if able to do so, shall complete a portion of such report describing how the injury or illness occurred. Unless the report is transmitted on computer input media, the physician shall file the original signed report with the insurer or self-insured employer.
(b) If treatment is for pesticide poisoning or for a condition suspected to be pesticide poisoning, the physician shall also file a complete report directly with the Division within five days after initial treatment. In no case shall treatment administered for pesticide poisoning or suspected pesticide poisoning be deemed to be first aid treatment.
(c) The reports required by this Section shall be made on Form 5021, Rev. 5, Doctor's First Report of Occupational Injury or Illness (sample forms may be secured from the Division), upon a form reproduced in accordance with Section 14007, or by use of computer input media prescribed by the Division and compatible with the Division's computer equipment. However, reports may be submitted on Revision 4 of Form 5021 for dates of service prior to October 1, 2015. Although ICD-10 coding is required on or after October 1, 2015, for a twelve-month period ending October 1, 2016, no medical treatment or medical-legal bill shall be denied based solely on an error in the level of specificity of the ICD-10 diagnosis code(s) used. Providers may use either version of the form until December 31, 2015. As of January 1, 2016, providers must use the 2015 version of the form.
(d) Physicians who use computerized data collection and reporting systems shall keep the injured worker's statement with the patient's medical records.
1. New
section filed 2-8-80; designated effective 5-1-80 (Register 80, No.
6).
2. Amendment of subsection (c) filed 1-13-83; effective
thirtieth day thereafter (Register 83, No. 3).
3. Amendment filed
6-14-89; operative 7-14-89 (Register 89, No. 25).
4. Editorial
correction of printing error in subsection (a) (Register 90, No.
6).
5. Amendment of subsections (a) and (c) filed 1-14-93; operative
2-16-93 (Register 93, No. 3).
6. Editional correct of printing error
in subsection (c) (Register 93, No. 44).
7. Amendment of subsection
(c) filed 9-21-2015; operative 10-1-2015 pursuant to Government Code section
11343.4(b)(3) (Register 2015, No. 39).
Note: Authority cited: Section 6410, Labor Code. Reference: Sections 6409(a), 6409.3, and 6410, Labor Code.
