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AB-1107 Workers’ compensation.(2019-2020)

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Date Published: 04/22/2019 09:00 PM
AB1107:v97#DOCUMENT

Amended  IN  Assembly  April 22, 2019
Amended  IN  Assembly  March 26, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 1107


Introduced by Assembly Member Chu
(Coauthor: Assembly Member Reyes)

February 21, 2019


An act to add Section 4610.2 to amend Section 4610.1 of the Labor Code, relating to workers’ compensation.


LEGISLATIVE COUNSEL'S DIGEST


AB 1107, as amended, Chu. Workers’ compensation: medical treatment: exemption from utilization review. 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 employment. Existing law requires an employer to provide medical, surgical, chiropractic, acupuncture, and hospital treatment that is reasonably required to cure or relieve the injured worker from the effects of the injury. Existing law requires each employer to establish a utilization review process to review and approve, modify, or deny treatment recommendations and establishes an independent medical review process to resolve disputes over a utilization review decision. Existing law also establishes the Workers’ Compensation Appeals Board (appeals board) to exercise all judicial powers vested in it, including workers’ compensation proceedings for the recovery of compensation.

This bill would exempt medical treatment requested by a primary or secondary treating physician from the utilization review process and from dispute on the grounds of medical necessity if either (1) the employee suffers from a serious chronic condition, as defined, the requested treatment has been previously authorized by the employer, and the employer fails to demonstrate a specified change in the employee’s circumstances or condition, or (2) the employer has established a medical provider network and the requesting physician is a member of the medical provider network. The bill would require the appeals board to resolve disputes arising under this exemption.

Existing law requires, when payment of compensation has been unreasonably delayed or refused, either prior to or subsequent to the issuance of an award, the amount of the payment unreasonably delayed or refused to be increased up to 25% or up to $10,000, whichever is less, except for unreasonable delay in the provision of medical treatment for periods of time necessary to complete the utilization review process. Existing law provides that a determination by the appeals board or a final determination of the administrative director pursuant to independent medical review that medical treatment is appropriate is not conclusive evidence that medical treatment was unreasonably delayed or denied for purposes of imposing those penalties.
This bill would exclude a final determination of the administrative director pursuant to independent medical review from the latter provision regarding conclusive evidence that medical treatment was unreasonably delayed or denied.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YESNO   Local Program: NO  

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


SECTION 1.

 Section 4610.1 of the Labor Code is amended to read:

4610.1.
 An employee shall not be is not entitled to an increase in compensation under Section 5814 for unreasonable delay in the provision of medical treatment for periods of time necessary to complete the utilization review process in compliance with Section 4610. A determination by the appeals board or a final determination of the administrative director pursuant to independent medical review that medical treatment is appropriate shall not be is not conclusive evidence that medical treatment was unreasonably delayed or denied for purposes of penalties under Section 5814. In no case shall this section This section does not preclude an employee from entitlement to an increase in compensation under Section 5814 when an employer has unreasonably delayed or denied medical treatment due to an unreasonable delay in completion of the utilization review process set forth in Section 4610.

SECTION 1.Section 4610.2 is added to the Labor Code, to read:
4610.2.

(a)Medical treatment that is requested by a primary or secondary treating physician is not subject to Section 4610 or otherwise subject to dispute on the grounds of medical necessity if either of the following conditions is met:

(1)(A)The employee suffers from a serious chronic condition as defined in subparagraph (B) of paragraph (3) of subdivision (d) of Section 4616.2.

(B)The requested treatment has been previously authorized by the employer and the employer fails to demonstrate a change in the employee’s circumstances or condition which would render the treatment no longer reasonably required to cure or relieve the employee from the effects of the industrial injury.

(2)The employer has established a medical provider network pursuant to Section 4616 and the requesting physician is a member of the medical provider network.

(b)The appeals board shall resolve disputes arising under this section.

(c)This section does not limit the right of the employer to contest treatment recommendations on grounds other than medical necessity.