§ 10163. Apportionment Referral.

STATE OF CALIFORNIA Department of Industrial Relations Department of Workers' Compensation DISABILITY EVALUATION UNIT

Date: __________ TO: Presiding Workers' Comp. Judge, __________

(Office) __________ FROM: Disability Evaluation Unit, __________

(Office) __________

SUBJECT: DEU File: Employee: QME: Date of Report:

The attached formal medical evaluation report indicates that part or all of the permanent disability may be subject to apportionment pursuant to Labor Code Section 4663 and/or Labor Code Section 4664. Please determine whether the apportionment is inconsistent with the law.

If you believe the apportionment is inconsistent with the law, you may refer the report back to the medical evaluator for correction or clarification. If you receive no response from the medical evaluator within 30 days from your request, please make your determination based on the original report.

After checking the appropriate space, sign and date the bottom of this form and return it with the medical report to the DEU office listed above. Thank you.

The apportionment: IS CONSISTENT __________ or IS NOT CONSISTENT __________with the law.

__________, Workers' Compensation Judge (Signature)

__________ (Date)

NOTE: This memorandum is an administrative document and is not admissible in any judicial proceeding.

DEU Form 105 (Rev 12-04)

HISTORY

1. New section filed 4-25-91; operative 4-25-91 (Register 91, No. 26). New section is exempt from review by OAL pursuant to Government Code section 11351.

2. Amendment of section and 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 A Certificate of Compliance must be transmitted to OAL by 5-2-2005 or emergency language will be repealed by operation of law on the following day.

3. Certificate of Compliance as to 12-31-2004 order, including further amendment of Note, transmitted to OAL 4-29-2005 and filed 6-10-2005 (Register 2005, No. 23).

Note

Note: Authority cited: Sections 133 and 5307.3, Labor Code. Reference: Sections 124, 4061, 4062, 4062.01, 4062.1, 4062.2, 4062.5, 4064, 4067, 4660, 4662, 4663 and 4664, Labor Code.