Workers’ Comp Reform
An overview of the changes

SB 899, the new workers’ compensation compromise bill, passed both houses of the Legislature on April 16th. Key elements of the package that could substantially reduce system costs include the following:

• Requires disability reports to be based on objective standards developed by the American Medical Association, and requires the disability schedule to be objective and consistent;

• Ensures employers are only responsible for the portion of the injured workers' disability that is the result of their existing job;

• Closes a loophole that allowed multiple disability awards in excess of 100 percent of disability;

• Permits employers greater control over unnecessary medical utilization by requiring injured workers to be treated by a physician network chosen by the employer. However, injured workers dissatisfied with their care are permitted to change doctors within the network and obtain independent medical review;

• Ensures medical treatment follows objective, nationally recognized guidelines;

• Establishes clear parameters for what is acceptable treatment for injured workers in the workers' compensation system;

• Reduces excessive litigation by reducing the friction in the permanent disability system, ensuring that doctors, not lawyers and judges, resolve medical decisions. The following details the major changes included in SB899.
 

Issue

Existing Law

SB899

  Specifies that measurements of physical elements of disability should follow the recommendation of the Joint Committee of the California Medical Association and Industrial Accident Commission published in 1960. Requires procedures for determining
diagnosis and treatment to be in
accordance with the American
College of Occupational and
Environmental Medicine (ACOEM)
guidelines and where ACOEM is not
applicable, with peer reviewed,
evidence-based, nationally
recognized standards of care.

Restricts the admissibility of
evidence of disability or
reasonableness of medical treatment
to reports that comply with the
procedures above.
Medical Provider
Networks
Allows an employer to contract with a state certified health care organization (HCO) for provision of medical care. Allows employers to contract with closed networks of doctors the same way they do now in group health. In exchange, the employee would be allowed to change doctors within the network.

The network must meet certain requirements to ensure adequate and appropriate care (sufficient geographic coverage, an adequate number of specialists, a specified percentage of physicians who are primarily non-occupational, timelines for seeing network doctors, continuity of care, etc)

The worker could see up to three different doctors within the network and is then eligible for an in person independent medical review (IMR)

The employer pays for IMR. If the IMR sides with the injured worker, the employee can receive his or her medical treatment outside of the network at the expense of the employer.
Predesignation of Physician The employer has medical control for the first thirty days after an injury is reported. If the employee pre-designated a personal physician, the employee has the right to be treated by that physician from the date of the injury. Under the following conditions, the worker would be allowed to receive care from their group HMO or PPO instead of from the employer’s network:

• If the employer provides group health insurance and the worker pre-designates his or her treating3 physician within the group.

• Referrals to specialists are approved by the insurer and take place within the HMO or PPO.

The total number of workers who pre-designate does not exceed 7 percent.

In cases where the employee predesignates, he or she would be bound by all of the rules of group health insurance.

The Division of Workers’ Compensation would study predesignation to see whether it is cost effective. The right to predesignate would sunset in three years.

Immediate Medical Care Allows for up to 90 days to make a decision on a claim and to begin providing the necessary medical care. Rather than allowing an employer 90 days to begin treatment, employees would receive immediate medical treatment with a cap of $10,000.
Standard of Care Provides for treatment that is reasonably required to “cure and relieve” from the effects of the injury. The current standard of care, ‘cure and relieve” is defined as treatment in accordance with American College of Occupational and Environmental Medicine (the treatment guidelines in last year’s legislation).
24 Hour Care Pilots Provides for carve-out programs, which permit the same basic benefits to be delivered when a union and an employer establish an alternate dispute resolution process instead of the usual litigation process. Expands carve-out programs to allow a seamless health and disability system, without regard to the cause of the sickness or disability, provided they maintain the statutory minimums for PD benefits. The option for 24-hour integrated coverage would be included within the existing carve-out programs.
Repeal of the Treating Physician Presumption The opinion of the treating physician is presumed to be correct if the physician was predesignated. Repeals the treating physician presumption for pre-designated physicians.
5814 Penalties When payment of compensation has been unreasonably delay or refused, the entire species of benefits is increased by 10%. TD, PD, and medical treatment are all considered species of benefits. When payment of compensation has been unreasonably delay or refused:

• The penalty would be 25 percent of the late payment. There would be a $10,000 cap on a 5814 penalty. Late payment to a medical provider would not constitute a 5814 penalty unless significant harm was caused to the worker as a result of the late payment (he or she didn’t receive a necessary treatment, for example).

• If an insurer discovered that they had failed to pay a claim on time or at the right amount, they could “self-correct” by sending it off with an additional 10 percent added. This would have to happen before a 5814 was filed.

• There is a penalty for pattern of practice of up to $400,000.

• There would be a two-year statute of limitations on 5814 penalties.

Causation Provides compensation for any injury arising out of and occurring in the course of employment. The injury may be specific or cumulative and employment need not be the sole cause of the injury. No change.
Permanent Disability Apportionment When a pre-existing disease is aggravated by an industrial injury, allows for compensation due to the aggravation. An employee with a previous permanent disability is entitled to compensation only for the increase in disability resulting from the industrial injury. Apportions compensation to any non-work cause: an existing injury, health condition, etc. Requires doctors’ reports to address the issue of apportionment.

Caps multiple awards so that an individual cannot get more than 100 percent disability for any single region of the body. Specifies that in no case shall an injured worker receive cumulative awards that exceed the benefit of a total permanent disability award.

Requires an employee to disclose all relevant injuries and all previous relevant compensated injuries.

Creates a conclusive presumption that prior awards or stipulations continue to exist.

Temporary Disability Caps TD at 240 weeks within a period of 5 years from the date of injury. Caps TD at 104 weeks within 2 years from the first payment by an employer.

Specifies that workers with the following conditions can receive TD longer than 104 weeks.

• Acute and Chronic Hepatitis A and C

• HIV

• Amputations

• Severe Burns

• High Velocity Eye Injuries and Chemical Burns to the Eyes

• Pulmonary Fibrosis and Chronic Lung Disease

Insurance Rate Report N/A Requires the Division of Workers’ Compensation in consultation with Department of Insurance to contract for a report on the impact that the cost savings from this bill and last year’s form bills have on rates. Requires the study to address the appropriateness of rate regulation.
User Funding Until 1/1/04, the Division of Workers’ Compensation was funded 20% by user funding and 80% from the General Fund. Last year’s legislation intended to provide for 100% user funding, but that never happened due to an error with the language. Restores 100% user funding of the Division of Workers’ Compensation.
Return to Work Program Provides for a return to work program for small employers that was unfunded. Establishes and funds (through user funding) a return to work program that provides up to $2500 to small employers who need to make workplace modifications in order to return injured workers to their jobs.