Deu Form 105 PDF Details

Navigating the complexities of workers' compensation in California can seem daunting, especially when it comes to understanding specific forms and their purposes. One such form, the DEU 105, plays a crucial role within the state's Department of Industrial Relations, specifically under the Division of Workers' Compensation. This form serves as a communication tool between the Disability Evaluation Unit (DEU) and the presiding Workers' Compensation Judge. It focuses on the evaluation of permanent disability claims, particularly examining whether any portion of the disability is subject to apportionment under Labor Code Section 4663 and/or Labor Code Section 4664. Apportionment, in this context, determines if a part of the worker's permanent disability can be attributed to causes other than the work-related injury. The DEU 105 form requires the judge to review a formal medical evaluation report attached by the DEU, offering insight into the case's complexity. It asks the judge to assess if the apportionment suggested by the medical evaluator aligns with legal standards. Judges have the authority to either accept the apportionment as provided, or, if it seems inconsistent with the law, request further clarification from the medical evaluator. This process ensures that workers' compensation claims are evaluated thoroughly, with an aim to uphold the fair application of law. Notably, the DEU 105 form itself is an administrative document, meaning it's designed for internal use within the judicial system and isn't admissible as evidence in court proceedings. Understanding the role and functioning of the DEU 105 form sheds light on the procedural aspects of handling workers' compensation claims in California, highlighting the state's intricate system designed to protect workers and employers alike.

QuestionAnswer
Form NameDeu Form 105
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesdeu105 deuform

Form Preview Example

STATE OF CALIFORNIA

Department of Industrial Relations

Division 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. 01/01/05)

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