BILL ANALYSIS
AB 361
Page 1
Date of Hearing: April 22, 2009
ASSEMBLY COMMITTEE ON INSURANCE
Joe Coto, Chair
AB 361 (Lowenthal) - As Amended: April 13, 2009
SUBJECT : Workers' compensation
SUMMARY : Precludes an employer from refusing to pay for
workers' compensation medical treatment services if the employer
has approved those services prior to the time the medical
provider treated the claimant. Specifically, this bill :
1)Provides that, regardless of whether the employer has
established a medical provider network, an employer that
authorizes medical treatment cannot rescind or modify the
approval after the services are provided.
2)States that nothing in the above rules can be construed to
expand or alter the benefits available under, or the terms and
conditions of, any contract.
EXISTING LAW :
1)Establishes a comprehensive system of workers' compensation
benefits for workers injured during employment, including
medical treatment benefits.
2)Prohibits, in the context of health insurance, a health plan
or insurer from rescinding or modifying an authorization for
medical services after the services are rendered.
FISCAL EFFECT : Undetermined.
COMMENTS :
1)Purpose . The author introduced this bill at the request of
the California Chiropractic Association, which reports that
many of its members have experienced billing problems when
billing for services that had been previously approved by the
appropriate payor. While the problem in the market was raised
by chiropractors, the solution properly applies to any
workers' compensation medical treatment services that have
been properly pre-approved.
AB 361
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2)Related law . Last Session, the Legislature passed, and the
Governor signed, AB 1324 (De La Torre). AB 1324 established
in the health insurance context the same rule proposed here
for the workers' compensation system. The principles are the
same: if the responsible party authorizes a medical provider
to treat a patient, then it is inappropriate for that same
party to decline to pay for the treatment once it has been
provided.
3)Employer Concerns . Employers have expressed concerns to the
Author and Committee staff that the bill may have unintended
consequences. The concern that was expressed was that the
language might unintentionally preclude the employer from
modifying or reversing its decision for services not yet
rendered. Despite agreeing to propose language, as of the
preparation of this analysis, language had not been proposed
by those expressing concerns. However, the author has agreed
in principle to clarify the bill's provisions. One option to
clarify this point would be to add the phrase "after the
medical treatment has been provided" on page 2, line 7, after
the word "authorization."
REGISTERED SUPPORT / OPPOSITION :
Support
American Federation of State, Municipal, and County Employees
(AFSCME)
Association for Los Angeles Deputy Sheriffs
California Applicants' Attorneys Association
California Chiropractic Association (CCA)
California Medical Association (CMA)
California Nurses Association/National Nurses Organizing
Committee
California State Employees Association (CSEA)
CSAC-EIA California Joint Powers Authority
Glendale City Employees Association
Los Angeles Probation Officers' Union, AFSCME, Local 685
Orange County Professional Firefighters' Association
Organization of SMUD Employees
Riverside Sheriffs' Association
San Bernardino Public Employees Association
Santa Rosa City Employees Association
Opposition
AB 361
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Association of California Insurance Companies (ACIC)
California Association of Joint Powers Authorities (unless
amended)
Analysis Prepared by : Mark Rakich / INS. / (916) 319-2086