Actual Text of Labor Code §4060
“This section shall apply to a disputed claim where the compensability of the injury has not been accepted. The employer shall provide a form prescribed by the administrative director with which the employee may request a medical evaluation to determine whether the injury is compensable.”
— Cal. Labor Code §4060
What Is Labor Code §4060?
Labor Code §4060 applies when your workers’ compensation claim is completely denied—meaning the insurance company says your injury isn’t work-related at all. This section governs how medical evaluations are used to resolve that dispute.
At Employees First Labor Law, we regularly use §4060 to help injured workers overturn wrongful denials and get back on track with treatment and benefits.
When Does §4060 Apply?
- Total Denial: The insurance company rejects your claim outright—not just part of it.
- Causation Dispute: They argue the injury did not happen at work or was not caused by your job duties.
- Triggering Evaluation Rights: Once denied, you’re entitled to a Qualified Medical Evaluator (QME) or Agreed Medical Evaluator (AME) exam.
QME vs. AME: What’s the Difference?
- QME (Qualified Medical Evaluator)
For unrepresented workers. You’ll request a panel of state-certified doctors and select one. - AME (Agreed Medical Evaluator)
If you have a lawyer, both sides can agree on a single doctor to evaluate you.
These evaluations determine whether your injury is covered by workers’ comp—and can unlock medical care, wage replacement, and permanent disability payments.
Time-Sensitive Process
- If you have an attorney, you must strike a QME from the panel within 10 days.
- If you don’t respond, the insurance company may choose for you—often resulting in a biased doctor.
That’s why it’s critical to act quickly and involve experienced legal counsel to protect your rights.
How EFLL Helps With §4060 Evaluations
At Employees First Labor Law, we:
✅ Request and manage QME or AME selection
✅ Prepare you for the medical-legal exam
✅ Challenge inaccurate or insurer-friendly reports
✅ Push to reverse claim denials based on solid medical evidence
We’ve helped hundreds of workers turn denials into accepted cases using §4060.
Learn More
Want to better understand how this fits into the broader workers’ comp system?
Check out our guide: Top 25 California Labor Codes for Workers’ Compensation
It breaks down all the key statutes that protect injured workers in 2025.
Final Takeaway
Labor Code §4060 gives you a legal tool to fight back when your workers’ comp claim is denied. Don’t go through this process alone. One bad evaluation can sink your entire case—but the right legal strategy can change everything.
