Dear Claims Administrator:

On 02-22-06, I evaluated Mr. Ignacio Castellanos (“patient”) in my San Jose office and have subsequently prepared this report. The patient required the assistance of a Spanish-speaking translator. Mr. Edwin Rosero of Communicade provided Spanish to English translation throughout this 1.75 hour interview and evaluation. Because of the language barrier, the time required for completion of my examination and history was longer than usual.

Unfortunately, in this case we have a “disputed medical fact” as defined under Title 8 CCR section 9793 (e) that has resulted in a “contested claim,” as defined under Title 8 CCR section 9793 (b). More explicitly, the insurer (FARA) has denied requested medical treatment, medical testing, and medical second opinions (see insurer denial letters dated 08-05-05, 08-18-05, 08-23-05, 10-24-05, and 02-03-06).

The patient, who is a party to this case, has asked me, the primary treating physician, to perform at “comprehensive medical legal evaluation,” as defined under Title 8 CCR section 9793 (c), “for the purpose of proving or disproving a contested claim.”

A primary treating physician, if so asked by a party to the claim, is allowed to perform such a comprehensive medical legal evaluation per Title 8 CCR section 9793 (c) (2). Furthermore, such a report constitutes a “medical-legal expense” as defined under Title 8 CCR section 9793 (g) and is payable under the medical legal fee schedule in accordance with Title 8 CCR section 9795.

Therefore, this comprehensive medical-legal evaluation and report, which is in compliance with Title 8 CCR section 10606, and Labor Code sections 4628 and 139.2, shall fulfill the patients request and is hereby submitted to all interested parties.

The following Time Expenditures and Complexity Factors, as defined by CCR 9795(c), were met in the preparation of this report:

Complexity Factor #1) 1.75 hours of doctor-patient face-to-face time was spent as I took a detailed and precise history, performed a comprehensive AMA-style examination, and answered a series of patient questions after the evaluation.

Complexity Factor #2) 4.5 hours of record, and radiographic review (including all AMA mandated line drawing and angle measuring) was expended in the preparation of this report. My work product is attached at the end of this paper as mandated by LC 4062.3(d). Noteworthy is the fact there is slightly over 4 inches of medical records.

Complexity Factor #3) 3.0 hours of medical and medical-legal research was expended in the preparation of this report as mandate/supported by Labor Code §4604.5, Title 8 CCR §10606(n), and Escobedo vs. CNA (2005) 70 CCC 604.

Complexity Factor #5) “six or more hours spent on any combination of three complexity factors (1)-(3) shall count as three complexity factors,” was also met in this report.

Complexity Factor #7) The issue of APPORTIONMENT was discussed in detail and was a bona fide issue secondary to the discovery of discopathy, degenerative disc disease and degenerative joint disease on imaging. This factor needed to be addressed per Escobedo vs. CNA (Supra).

8) 4.0 hours were needed to assimilate all information and prepare this report.

This comprehensive med-legal evaluation qualifies and will be billed as a ML104 as it has met the required “four or more complexity factors” as outlined in CCR 9795(c). Therefore, my billable time expenditure was 13.25 hours; see above for details.

The review of records, as mandated by LC 4062.3(d), has been incorporated into the history of this report, as well as listed separately on the very last pages.