Form Pr-3 - Primary Treating Physician'S Permanent And Stationary Report (Page 5 of 8) in pdf

STATE OF CALIFORNIA

Division of Workers’ Compensation

PRIMARY TREATING PHYSICIAN’S PERMANENT AND STATIONARY REPORT (PR-3)

Apportionment:

Effective April 19, 2004, apportionment of permanent disability shall be based on causation. Furthermore, any

physician who prepares a report addressing permanent disability due to a claimed industrial injury is required to

address the issue of causation of the permanent disability, and in order for a permanent disability report to be

complete, the report must include an apportionment determination. This determination shall be made pursuant to

Labor Code Sections 4663 and 4664 set forth below:

Labor Code Section 4663. Apportionment of permanent disability; Causation as basis; Physician's report;

Apportionment determination; Disclosure by employee

(a) Apportionment of permanent disability shall be based on causation.

(b) Any physician who prepares a report addressing the issue of permanent disability due to a claimed industrial injury

shall in that report address the issue of causation of the permanent disability.

apportionment determination. A physician shall make an apportionment determination by finding what approximate

percentage of the permanent disability was caused by the direct result of injury arising out of and occurring in the

course of employment and what approximate percentage of the permanent disability was caused by other factors both

before and subsequent to the industrial injury, including prior industrial injuries. If the physician is unable to include

an apportionment determination in his or her report, the physician shall state the specific reasons why the physician

could not make a determination of the effect of that prior condition on the permanent disability arising from the injury.

The physician shall then consult with other physicians or refer the employee to another physician from whom the

employee is authorized to seek treatment or evaluation in accordance with this division in order to make the final

determination.

(d) An employee who claims an industrial injury shall, upon request, disclose all previous permanent disabilities or

physical impairments.

Labor Code Section 4664. Liability of employer for percentage of permanent disability directly caused by

injury; Conclusive presumption from prior award of permanent disability; Accumulation of permanent

disability awards

(a) The employer shall only be liable for the percentage of permanent disability directly caused by the injury arising

out of and occurring in the course of employment.

(b) If the applicant has received a prior award of permanent disability, it shall be conclusively presumed that the prior

permanent disability exists at the time of any subsequent industrial injury. This presumption is a presumption affecting

the burden of proof.

(c)(1) The accumulation of all permanent disability awards issued with respect to any one region of the body in favor

of one individual employee shall not exceed 100 percent over the employee's lifetime unless the employee's injury or

illness is conclusively presumed to be total in character pursuant to Section 4662. As used in this section, the regions

of the body are the following:

DWC Form PR-3 (Rev. 01/01/05)

Form Pr-3 - Primary Treating Physician'S Permanent And Stationary Report Page 5