Amended IN Assembly March 26, 2019 CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 1107Introduced by Assembly Member Chu(Coauthor: Assembly Member Reyes)February 21, 2019 An act to add Section 4610.2 to the Labor Code, relating to workers compensation. LEGISLATIVE COUNSEL'S DIGESTAB 1107, as amended, Chu. Workers compensation: medical treatment. treatment: exemption from utilization review.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 state the intent of the Legislature to enact legislation that would ensure that injured workers receive prompt medical examinations, diagnosis, and reasonable and necessary treatment for work-related injuries and receive their monetary and nonmonetary benefits expeditiously.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 employees 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.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: NOYES Local Program: NO Bill TextThe people of the State of California do enact as follows: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 employees 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.SECTION 1.The Legislature hereby recognizes that workers in this state who are injured while working are routinely victimized by long delays in receiving medical attention and treatment. The Legislature further recognizes that these workers often do not have access to physicians willing to treat them within the current system and that lack of access is particularly acute in many medical specialties, including cardiology, oncology, gastroenterology, and urology. Delay and lack of access cause or are accompanied by delays in receipts of monetary and nonmonetary workers compensation benefits. It is the intent of the Legislature to enact legislation that would ensure that injured workers receive prompt medical examinations, diagnosis, and reasonable and necessary treatment for work-related injuries, that shall include treatment by a medical specialist if appropriate. It is further the intent of the Legislature to enact legislation that would ensure that injured workers receive their monetary and nonmonetary benefits expeditiously, as required pursuant to Section 4 of Article XIV of the California Constitution.
Amended IN Assembly March 26, 2019 CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 1107Introduced by Assembly Member Chu(Coauthor: Assembly Member Reyes)February 21, 2019 An act to add Section 4610.2 to the Labor Code, relating to workers compensation. LEGISLATIVE COUNSEL'S DIGESTAB 1107, as amended, Chu. Workers compensation: medical treatment. treatment: exemption from utilization review.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 state the intent of the Legislature to enact legislation that would ensure that injured workers receive prompt medical examinations, diagnosis, and reasonable and necessary treatment for work-related injuries and receive their monetary and nonmonetary benefits expeditiously.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 employees 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.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: NOYES Local Program: NO
Amended IN Assembly March 26, 2019
Amended IN Assembly March 26, 2019
CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION
Assembly Bill No. 1107
Introduced by Assembly Member Chu(Coauthor: Assembly Member Reyes)February 21, 2019
Introduced by Assembly Member Chu(Coauthor: Assembly Member Reyes)
February 21, 2019
An act to add Section 4610.2 to the Labor Code, relating to workers compensation.
LEGISLATIVE COUNSEL'S DIGEST
## LEGISLATIVE COUNSEL'S DIGEST
AB 1107, as amended, Chu. Workers compensation: medical treatment. treatment: exemption from utilization review.
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 state the intent of the Legislature to enact legislation that would ensure that injured workers receive prompt medical examinations, diagnosis, and reasonable and necessary treatment for work-related injuries and receive their monetary and nonmonetary benefits expeditiously.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 employees 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 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 state the intent of the Legislature to enact legislation that would ensure that injured workers receive prompt medical examinations, diagnosis, and reasonable and necessary treatment for work-related injuries and receive their monetary and nonmonetary benefits expeditiously.
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 employees 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.
## Digest Key
## Bill Text
The people of the State of California do enact as follows: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 employees 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.SECTION 1.The Legislature hereby recognizes that workers in this state who are injured while working are routinely victimized by long delays in receiving medical attention and treatment. The Legislature further recognizes that these workers often do not have access to physicians willing to treat them within the current system and that lack of access is particularly acute in many medical specialties, including cardiology, oncology, gastroenterology, and urology. Delay and lack of access cause or are accompanied by delays in receipts of monetary and nonmonetary workers compensation benefits. It is the intent of the Legislature to enact legislation that would ensure that injured workers receive prompt medical examinations, diagnosis, and reasonable and necessary treatment for work-related injuries, that shall include treatment by a medical specialist if appropriate. It is further the intent of the Legislature to enact legislation that would ensure that injured workers receive their monetary and nonmonetary benefits expeditiously, as required pursuant to Section 4 of Article XIV of the California Constitution.
The people of the State of California do enact as follows:
## The people of the State of California do enact as follows:
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 employees 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.
SECTION 1. Section 4610.2 is added to the Labor Code, to read:
### SECTION 1.
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 employees 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.
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 employees 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.
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 employees 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.
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 employees 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.
The Legislature hereby recognizes that workers in this state who are injured while working are routinely victimized by long delays in receiving medical attention and treatment. The Legislature further recognizes that these workers often do not have access to physicians willing to treat them within the current system and that lack of access is particularly acute in many medical specialties, including cardiology, oncology, gastroenterology, and urology. Delay and lack of access cause or are accompanied by delays in receipts of monetary and nonmonetary workers compensation benefits. It is the intent of the Legislature to enact legislation that would ensure that injured workers receive prompt medical examinations, diagnosis, and reasonable and necessary treatment for work-related injuries, that shall include treatment by a medical specialist if appropriate. It is further the intent of the Legislature to enact legislation that would ensure that injured workers receive their monetary and nonmonetary benefits expeditiously, as required pursuant to Section 4 of Article XIV of the California Constitution.