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Lawmakers returned to Sacramento this week for the final four weeks of session. In that time, they will cast votes on hundreds of bills, including several dealing with Californias workers compensation system.
Here are the key issues to watch:
Limitations on Apportionment When an injured worker qualifies for permanent disability benefits, a physician must allocate which percentage of disability is due to the workplace injury and which percentage is due to other factors, such as prior work injuries or non-work causes. This process is referred to as apportionment.
Assembly Bill 1643 (Gonzalez) would ban apportionment for certain medical conditions, including pregnancy, menopause, osteoporosis, or carpal tunnel syndrome. This bill and a related lawsuit filed in June allege that Californias workers compensation system is gender-biased because these conditions occur more frequently among women. This allegation has been refuted by Californias Director of Industrial Relations, and Governor Brown vetoed similar legislation last year. AB 1643 would require California employers to pay for disability unrelated to work when caused by these conditions something current law protects against. The bill would also mandate that disability ratings for breast cancer be equal to ratings for prostate cancer. This provision applies an arbitrary rating to a single disease rather than the current requirement that permanent impairment from all work injuries and illnesses be measured using objective medical criteria.
Medical Treatment Control Californias workers compensation system paid out more than $7.5 billion to provide medical treatment to injured workers in 2014. After seven years in which average medical costs per claim increased by 50%, average medical costs started to decline in 2012 due largely to the SB 863 legislative reforms. Key to this decrease has been the strengthening of tools employers use to ensure that medical treatment requests conform to evidence-based medical guidelines.
Although an estimated 95% of all medical treatment requests are approved (and 89% of all denials are upheld through the states independent medical review process as being evidence based), some stakeholders have called for streamlining reviews for some treatment to reduce frictional costs. These costs, related to utilization review and Independent Medical Review, have increased significantly in recent years.
Senate Bill 1160 currently proposes a number of changes to the UR process. However, the bill is not in its final form and is expected to be the legislative vehicle for a number of UR system changes that are still being negotiated.
Medical Fraud Related to discussions over looser medical controls is growing concern over medical fraud in the workers compensation system. Since March, the Center for Investigative Reporting has published a series of stories about medical fraud and the treatment of injured workers as a commodity that gets traded among medical professionals, lawyers, recruitment firms and other service providers. According to the coverage, more than 100 medical providers are currently under indictment or investigation for fraud by county district attorneys. These cases involve more than 100,000 injured worker claims and total $1 billion in costs to the system.
The news coverage has sparked interest among lawmakers in Sacramento in Californias tools for combatting workers compensation fraud. One proposal on the table is AB 1244 (Gray), which would prohibit medical providers who are convicted of Medicare fraud from treating workers compensation patients.
Please watch for further updates from the Workers Compensation Action Network during the final weeks of the legislative session.
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