EAMS: How to Request a DEU Rating

Author’s Note: Colleen Casey would like to gratefully acknowledge the assistance of Jill Comyford and Chuck Ellison in creating this blog. Jill came up with the idea for the blog and compiled all of the technical information. She also wrote the first draft of the text. Chuck wrote all of the detailed instructions and made sure everything was EAMS compliant.

The Unprocessed Documents Queue (UDQ) is where documents are sent when they can’t be processed. To avoid the UDQ and to keep your cases on track, it’s important to comply with the new filing requirements.

To assist parties in properly completing all forms, there is an entire section on the DIR website dedicated to completing OCR (Optical Character Recognition) forms. (The sample files show some outdated forms, but they demonstrate how to put the packages in the correct order.”) Specific examples of the most commonly filed forms can be found at:

http://www.dir.ca.gov/dwc/EAMS/EAMS_OCRFilers.html

Instructions for each form can be found by clicking on this link and scrolling down the selection of documents until you find the form you need to complete. Click on the link to that form, and you’ll find all the information you need to be EAMS compliant and to avoid the dreaded UDQ.

An unusually high number of “Requests for Consultative Ratings” and “DORs for a Rating MSCs” end up in the UDQ. (DORs are Declarations of Readiness to Proceed and MSCs are Mandatory Settlement Conferences.)

In addition, many DEU (Disability Evaluation Unit) ratings are requested, but after the forms are scanned into EAMS, the DEU rater never receives a task requesting that an injured worker’s impairment be rated. The most common error appears to be that the ADJ box is incorrectly checked on certain Separator and Cover Sheets, instead of the DEU box. These problems and many others are easily solved by following the checklist and the step-by-step instructions set forth below.

Also, for best results, we recommend that parties submit a DOR at the same time they submit their Request for Consultative Rating. This will assist the DEU in preparing ratings for reports that are desired by the assigned hearing date. This will avoid delays at the time of hearing and assist workload allocation for the DEU.

Documents MUST be assembled in the order listed in order to ensure EAMS compatibility.

I.  Checklist for filing a DOR for a Rating MSC:

Your filing package will consist of the following in this order:
___Document Cover Sheet
___Document Separator Sheet for DOR
___Declaration of Readiness form
___Document Separator Sheet for Medical Report
___Medical Report
___Document Separator Sheet for Proof of Service
___Proof of Service

___ DOCUMENT COVER SHEET

  • “Is this a new case?” – check the box “NO”
  •  If you are requesting the rating to include companion cases, check the box “Companion Cases Exist” otherwise, leave it blank
  • “Walkthrough” – check the box “NO” (see Reg 10280) – if the District Office is accepting DORs on a walk-through basis, and you are submitting it as such, check the box “YES”
  • “More than 15 Companion Cases” – check ONLY if there are more than 15 companion cases that you need included for performing a rating
  • “DATE” – enter the date you are preparing the DOR
  • “CASE NUMBER 1” – Enter the EAMS ADJ case number.  You cannot file a DOR unless an ADJ product delivery case exists.  A DOR is not a case opening document
  • Do NOT list:  SSN, Type (specific or CT) of injury, DOI or the body parts.  Leave those fields BLANK.  They are NOT necessary when you have an EAMS Case Number
  • Check the box “ADJ”
  • If and only if there are companion cases to be included in the rating MSC, for each one, list ONLY the EAMS ADJ case number

___ DOCUMENT SEPARATOR SHEET FOR DOR

  • Product Delivery Unit: select ADJ
  • Document Type: select LEGAL DOCS
  • Document Title: select DECLARATION OF READINESS TO PROCEED
  • Document Date: enter the date you are preparing the DOR
  • Author: enter YOUR Uniform Assigned Name only (unless you are an unrepresented injured worker) There are I&A guides to help pro pers fill out their forms: http://www.dir.ca.gov/dwc/iwguides.html

___ DECLARATION OF READINESS TO PROCEED

  • Enter the ADJ case number, the injured worker’s first and last name and the employer information
  • Check the correct box for your role (Employee, Applicant, Defendant, Lien Claimant) – It is mandatory that you check one box
  • Check the box “Rating MSC”
  • Check ONLY the boxes for: “Permanent Disability” and “Future Medical Treatment” (see * footnote on the form)
  • Enter the doctor’s name in the format JOHN JONES MD and date of report – you can enter ONLY one doctor’s name and report date.  If there is more than one (1) report to be rated, note that in the large text box on page 2 of the form, listing the name(s) of the doctor and the date of the report(s)
  • “Name of declarant or name of the law firm of the declarant” – Enter ONLY your UAN  – do not enter an individual’s name (unless you are an unrepresented injured worker) – If you are a lien claimant, enter your company name
  • Enter your address and phone number – be sure to use the address as shown on the online database and the date you are preparing the form.
  • Sign

NOTE:  File a medical report(s) ONLY if it is not already in the case

___ DOCUMENT SEPARATOR SHEET FOR MEDICAL REPORT

  • For Product Delivery Unit, select ADJ
  • For Document Type, select MEDICAL DOCS
  • For Document Title, select the appropriate category:  AME REPORTS, QME REPORTS or ALL MEDICAL REPORTS (All Medical Reports does not mean to attach “all” medical reports – it is to be used when the report is not by either an AME or QME, for example, when it is the treating doctor’s report)
  • For Document Date, enter the date of the report
  • For Author, enter the name of the doctor in the format: JOHN JONES MD (no  punctuation or special characters like periods, slashes, apostrophes or commas)
  • IF AND ONLY IF YOU ARE ATTACHING MORE THAN ONE MEDICAL REPORT, REPEAT THESE STEPS FOR EACH MEDICAL REPORT

___ DOCUMENT SEPARATOR SHEET FOR PROOF OF SERVICE

  • Product Delivery Unit: select ADJ
  • Document Type: select LEGAL DOCS
  • Document Title: select PROOF OF SERVICE
  • Document Date: enter the date you prepare the DOR
  • Author: enter YOUR Uniform Assigned Name only (unless you are an unrepresented injured worker)

II.  Checklist for filing a Request for Consultative Rating:

This Request is to be used ONLY in cases where the injured worker is represented

NOTE:  Once there is an ADJ case number, you can only submit this form – you cannot submit a Request for Summary Rating

Your filing package will consist of the following in this order:
___Document Cover Sheet
___Document Separator Sheet for Request for Consultative Rating
___Request for Consultative Rating form
___Document Separator Sheet for Medical Report
___Medical Report
___Document Separator Sheet for Proof of Service
___Proof of service

___ DOCUMENT COVER SHEET

  • “Is this a new case?” – check the box “YES” if there is no DEU Product Delivery Unit.  If a DEU Product Delivery Case already exists, check the box “NO”
  • If you are filing this as a DEU case opening document, you cannot request a consultative rating on companion cases – each case requires its own separate Request for Consultative Rating – do NOT check the box “Companion Cases Exist” – leave it BLANK
  • “Walkthrough” – check the box “NO” (see Reg 10280) – if the District Office is accepting Request for Consultative Rating on a walk-through basis, and you are submitting it as such, check the box “YES”
  • Do NOT check the box “More than 15 Companion Cases” even if there are
  • “DATE” – enter the date you are preparing the Request for Consultative Rating
  • “CASE NUMBER 1” – if filing this as a case opening document, LEAVE THIS BLANK.  If a DEU Product Delivery Case already exists, enter the case number.
  • If this is a case opening document list:  SSN (optional), Type (specific or CT) of injury, DOI and the body parts.  If a DEU Product Delivery Case already exists, LEAVE THESE FIELDS BLANK
  • Check the box “DEU”

___ DOCUMENT SEPARATOR SHEET FOR REQUEST FOR CONSULTATIVE RATING

  • Product Delivery Unit: select DEU
  • Document Type: select DEU FORMS
  • Document Title: select REQUEST FOR CONSULTATIVE RATING
  • Document Date: enter the date you are preparing the Request for Consultative Rating
  • Author: enter YOUR Uniform Assigned Name only

___ REQUEST FOR CONSULTATIVE RATING

  • Check the box “Mail-in” or “Walk-in”
  • Enter the SSN (optional)
  • Enter the Date of Birth of the injured worker
  • Enter the case number you put on the Document Cover Sheet.  You may list actual companion case numbers on this form but as noted above, do NOT list them on the Document Cover Sheet
  • Enter the DOI – if it is a CT, enter the start date – remember, the Document Cover Sheet has the correct DOI and supersedes what is on the form
  • Enter the injured worker’s name
  • Enter the injured workers’ occupation
  • Enter the Insurance Claim Number (optional)
  • Enter the date of the medical report
  • Enter the doctor’s name in the format JOHN JONES MD (no punctuation or special characters like periods, slashes, apostrophes or commas)
  • The form has space for three (3) medical reports – if there are more than three (3) that are to be rated, prepare an addendum, listing the date and name of the doctor.  The addendum page will immediately follow the form without a separator sheet
  • If the ADJ case has been set for hearing, enter the date of the hearing and check one box for the type of hearing.  If the ADJ is NOT set for hearing, LEAVE THESE BLANK
  • At the present time, only the UAN for a REPRESENTATIVES’ OFFICE can be entered in the “Rating Requested by” and “A copy of this request has been served on” fields.  Do NOT enter anything other than a UAN for a representatives’ office.  If you are a claims administrators’ office filing the form or if you are serving a claims administrators’ office, LEAVE THESE FIELDS BLANK. There is a change request pending to correct this and once in place, these instructions will be updated.

NOTE:  File a medical report(s) ONLY if it is not already in the case

___ DOCUMENT SEPARATOR SHEET FOR MEDICAL REPORT

  • Product Delivery Unit: select DEU
  • Document Type: select MEDICAL REPORTS
  • Document Title: select the appropriate ONE:  AME, DEFAULT QME (REPRESENTED WITH DOI ON/AFTER 1-1-05), PANEL QME (NON-REPRESENTED ALL DOI), REPRESENTED QME (REPRESENTED WITH DOI BEFORE 1-1-05) or TREATING PHYSICIAN
  • Document Date: enter the date of the report
  • Author: enter the name of the doctor in the format JOHN JONES MD (no punctuation or special characters like periods, slashes, apostrophes or commas)
  • IF AND ONLY IF YOU ARE ATTACHING MORE THAN ONE MEDICAL REPORT, REPEAT THESE STEPS FOR EACH MEDICAL REPORT)

NOTE:  if you only use the proof of service that is part of the form itself, you do not have to attach a separate proof of service

___ DOCUMENT SEPARATOR SHEET FOR PROOF OF SERVICE

  • Product Delivery Unit: select DEU
  • Document Type: select MISC
  • Document Title: select TYPED OR WRITTEN LETTER (note that there is a change request pending to add proof of service to the DEU document title list)
  • Document Date: enter the date you prepare the Request for Consultative Rating
  • Author: enter YOUR Uniform Assigned Name only

III.  Checklist for filing a Request for Summary Rating – QME

(DEU 101) or Treating Physician (DEU 102):

This Request is to be used ONLY in cases where the injured worker is unrepresented – but if there is an ADJ case number, you must use the Request for Consultative Rating

Your filing package will consist of the following in this order:
___Document Cover Sheet
___Document Separator Sheet for Request for Summary Rating
___Request for Summary Rating form
___Document Separator Sheet for Medical Report
___Medical Report
___Document Separator Sheet for Proof of Service
___Proof of service

___ DOCUMENT COVER SHEET

  • “Is this a new case?” – check the box “YES” if there is no DEU Product Delivery Unit.  If a DEU Product Delivery Case already exists, check the box “NO”
  • If you are filing this as a DEU case opening document, you cannot request a summary rating on companion cases – each case requires its own separate Request for Summary Rating – do NOT check the box “Companion Cases Exist” – leave it BLANK
  • “Walkthrough” – check the box “NO” (see Reg 10280) – if the District Office is accepting Request for Summary Rating on a walk-through basis, and you are submitting it as such, check the box “YES”
  • Do NOT check the box “More than 15 Companion Cases” even if there are
  • “DATE” – enter the date you are preparing the Request for Summary Rating
  • “CASE NUMBER 1” – if filing this as a case opening document, LEAVE THIS BLANK.  If a DEU Product Delivery Case already exists, enter the case number.
  • If this is a case opening document list:  SSN (optional), Type (specific or CT) of injury, DOI and the body parts.  If a DEU Product Delivery Case already exists, LEAVE THESE FIELDS BLANK
  • Check the box “DEU”

___ REQUEST FOR SUMMARY RATING FORM

  • Be sure to enter information in all the fields.  Select the correct address and city for the DEU location from the drop down list.  If there is a field for which you do not have the correct information, leave it blank
  • Enter the UAN for the claims administrators’ office – be sure to use their address as shown on the online database
  • If you are attaching a job description or job analysis, it immediately follows the form without a Document Separator Sheet

NOTE:  File a medical report(s) ONLY if it is not already in the case

___ DOCUMENT SEPARATOR SHEET FOR MEDICAL REPORT

  • Product Delivery Unit: select DEU
  • Document Type  select MEDICAL REPORTS
  • Document Title: select the appropriate ONE:  AME, DEFAULT QME (REPRESENTED WITH DOI ON/AFTER 1-1-05), PANEL QME (NON-REPRESENTED ALL DOI), REPRESENTED QME (REPRESENTED WITH DOI BEFORE 1-1-05) or TREATING PHYSICIAN
  • Document Date: enter the date of the report
  • Author: enter the name of the doctor in the format JOHN JONES MD (no punctuation or special characters like periods, slashes, apostrophes or commas)
  • IF AND ONLY IF YOU ARE ATTACHING MORE THAN ONE MEDICAL REPORT, REPEAT THESE STEPS FOR EACH MEDICAL REPORT

NOTE:  if you only use the proof of service that is part of the form itself, you do not have to attach a separate proof of service

___ DOCUMENT SEPARATOR SHEET FOR PROOF OF SERVICE

  • Product Delivery Unit: select DEU
  • Document Type: select MISC
  • Document Title: select TYPED OR WRITTEN LETTER (note, that there is a change request pending to add proof of service to the DEU document title list)
  • Document Date: enter the date you prepare the Request for Consultative Rating
  • Author: enter YOUR Uniform Assigned Name only

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