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AB-1815 Workers’ compensation.(2019-2020)

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Date Published: 01/23/2020 09:00 PM
AB1815:v98#DOCUMENT

Amended  IN  Senate  January 23, 2020

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 1815


Introduced by Committee on Insurance Assembly Members Daly and Salas

March 05, 2019


An act to repeal and add Section 3201.9 amend Section 5307.6 of the Labor Code, relating to workers’ compensation.


LEGISLATIVE COUNSEL'S DIGEST


AB 1815, as amended, Committee on Insurance Daly. Workers’ compensation.
Existing law establishes a workers’ compensation system, administered by the Administrative Director of the Division of Workers’ Compensation, to compensate an employee for injuries sustained in the course of the employee’s employment. Existing law requires the employer to provide medical, surgical, chiropractic, acupuncture, and hospital treatment, as specified, that is reasonably required to cure or relieve the injured worker from the effects of the worker’s injury. Existing law also requires the employer to reimburse the employee for the employee’s medical-legal expenses, as specified. Existing law requires the administrative director to adopt and revise a fee schedule for medical-legal expenses at the same time the director adopts and revises the medical fee schedule.
This bill would require the administrative director to adopt and revise the medical-legal fee schedule at least every 2 years and to do so separate and apart from adopting and revising the medical fee schedule.

Existing law establishes a workers’ compensation system, administered by the Administrative Director of the Division of Workers’ Compensation, to compensate an employee for injuries sustained in the course of that person’s employment. Existing law authorizes collective bargaining agreements between a private employer or groups of employers engaged in construction-related activities and a recognized or certified exclusive bargaining representative, and labor management agreements between an employer or groups of employers and a recognized or certified exclusive bargaining representative, that establish a dispute resolution process for workers’ compensation instead of the hearing before the Workers’ Compensation Appeals Board and its workers’ compensation administrative law judges, or that provide for other alternative workers’ compensation programs, medical providers and treatment, and safety committees. Existing law requires the Division of Workers’ Compensation to annually report to the Director of Industrial Relations the number of collective bargaining agreements received, the number of labor-management agreements received, and the number of employees covered by those agreements. Existing law also requires certain other related, but obsolete, reporting requirements, among other things, to biannually include updated loss experience with respect to aggregate data for employers participating in an alternative program established pursuant to these provisions, including, among other information, the projected incurred costs and actual costs of claims and the number of workers participating in vocational rehabilitation and light duty programs.

This bill would make those reporting requirements to provide updated information apply to the collective bargaining agreements and labor management agreements described above, make the reporting requirements annual, rather than biannual, and delete obsolete provisions and cross-references.

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 Section 5307.6 of the Labor Code is amended to read:

5307.6.
 (a) The administrative director shall adopt and revise a fee schedule for medical-legal expenses as defined by Section 4620, at least every two years, which shall be prima facie evidence of the reasonableness of fees charged for medical-legal expenses at the same time he or she adopts and revises expenses. The administrative director shall adopt and revise the medical-legal fee schedule pursuant to this section separate and apart from adopting and revising the medical fee schedule pursuant to Section 5307.1.
The schedule shall consist of a series of procedure codes, relative values, and a conversion factor producing fees which provide remuneration to physicians performing medical-legal evaluations at a level equivalent to that provided to physicians for reasonably comparable work, and which additionally recognizes the relative complexity of various types of evaluations, the amount of time spent by the physician in direct contact with the patient, and the need to prepare a written report.
(b) A provider shall not be paid fees in excess of those set forth in the fee schedule established under this section unless the provider provides an itemization and explanation of the fee that shows that it is both a reasonable fee and that extraordinary circumstances relating to the medical condition being evaluated justify a higher fee; provided, however, that in no event shall a provider a provider shall not charge in excess of his or her the provider’s usual fee. The employer and employee shall have standing to contest fees in excess of those set forth in the fee schedule.
(c) In the event of a dispute between the provider and the employer, employee, or carrier concerning the fees charged, the provider may be allowed a reasonable fee for testimony if the provider testified pursuant to the employer’s or carrier’s subpoena and the judge or referee determines that the fee charged was reasonable and justified by extraordinary circumstances.
(d) (1) No provider may request nor A provider shall not request or accept any compensation, including, but not limited to, any kind of remuneration, discount, rebate, refund, dividend, distribution, subsidy, or other form of direct or indirect payment, whether in money or otherwise, from any source for medical-legal expenses if such that compensation is in addition to the fees authorized by this section. In addition to being subject to discipline pursuant to the provisions of subdivision (k) of Section 139.2, any a provider violating this subdivision is subject to disciplinary action by the appropriate licensing board.
(2) This subdivision does not apply to medical-legal expenses for which the administrative director has not adopted a fee schedule.

SECTION 1.Section 3201.9 of the Labor Code is repealed.
SEC. 2.Section 3201.9 is added to the Labor Code, to read:
3201.9.

(a)On an annual basis, the report required in subdivision (h) of Section 3201.5 and subdivision (g) of Section 3201.7 shall include updated information pursuant to those sections. The report shall also include updated data regarding the information required pursuant to subdivision (h) of Section 3201.5 and subdivision (g) of Section 3201.7 for the previous year and for each subsequent year.

(b)(1)Upon completion of the report, the Division of Workers’ Compensation shall report the findings to the Legislature.

(2)The report described in paragraph (1) shall be submitted in accordance with Section 9795 of the Government Code.