BILL NUMBER: AB 1454 INTRODUCED
BILL TEXT
INTRODUCED BY Assembly Member Solorio
JANUARY 9, 2012
An act to amend Sections 139.2 and 3209.3 of the Labor Code,
relating to workers' compensation.
LEGISLATIVE COUNSEL'S DIGEST
AB 1454, as introduced, Solorio. Workers' compensation:
audiologists.
Existing workers' compensation law generally requires employers to
secure the payment of workers' compensation, including medical
treatment, for injuries incurred by their employees that arise out
of, or in the course of, employment. Existing law requires the
Administrative Director of the Division of Workers' Compensation to
appoint qualified medical evaluators in each of the respective
specialties as required for the evaluation of medical-legal issues.
This bill would also include doctors of audiology who meet
specified requirements among those medical professionals who may be
appointed by the administrative director as a qualified medical
evaluator.
Existing law, for purposes of workers' compensation, defines
"physician" to include physicians and surgeons holding specified
degrees, psychologists, acupuncturists, dentists, podiatrists, and
chiropractic practitioners licensed by California state law and
within the scope of their practice, as defined by state law.
This bill would also include licensed audiologists, as specified,
within that definition of physician.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 139.2 of the Labor Code is amended to read:
139.2. (a) The administrative director shall appoint qualified
medical evaluators in each of the respective specialties as required
for the evaluation of medical-legal issues. The appointments shall be
for two-year terms.
(b) The administrative director shall appoint or reappoint as a
qualified medical evaluator a physician, as defined in Section
3209.3, who is licensed to practice in this state and who
demonstrates that he or she meets the requirements in paragraphs (1),
(2), (6), (7), and (7),
(8), and, if the physician is a medical doctor,
doctor of osteopathy, doctor of chiropractic, a psychologist,
or a psychologist, doctor of audiology,
that he or she also meets the applicable requirements in
paragraph (3), (4), (5), or (5).
(6).
(1) Prior to his or her appointment as a qualified medical
evaluator, passes an examination written and administered by the
administrative director for the purpose of demonstrating competence
in evaluating medical-legal issues in the workers' compensation
system. Physicians shall not be required to pass an additional
examination as a condition of reappointment. A physician seeking
appointment as a qualified medical evaluator on or after January 1,
2001, shall also complete prior to appointment, a course on
disability evaluation report writing approved by the administrative
director. The administrative director shall specify the curriculum to
be covered by disability evaluation report writing courses, which
shall include, but is not limited to, 12 or more hours of
instruction.
(2) Devotes at least one-third of total practice time to providing
direct medical treatment, or has served as an agreed medical
evaluator on eight or more occasions in the 12 months prior to
applying to be appointed as a qualified medical evaluator.
(3) Is a medical doctor or doctor of osteopathy and meets one of
the following requirements:
(A) Is board certified in a specialty by a board recognized by the
administrative director and either the Medical Board of California
or the Osteopathic Medical Board of California.
(B) Has successfully completed a residency training program
accredited by the American College of Graduate Medical Education or
the osteopathic equivalent.
(C) Was an active qualified medical evaluator on June 30, 2000.
(D) Has qualifications that the administrative director and either
the Medical Board of California or the Osteopathic Medical Board of
California, as appropriate, both deem to be equivalent to board
certification in a specialty.
(4) Is a doctor of chiropractic and meets either of the following
requirements:
(A) Has completed a chiropractic postgraduate specialty program of
a minimum of 300 hours taught by a school or college recognized by
the administrative director, the State Board of
Chiropractic Examiners and the Council on Chiropractic Education.
(B) Has been certified in California workers' compensation
evaluation by a provider recognized by the administrative director.
The certification program shall include instruction on disability
evaluation report writing that meets the standards set forth in
paragraph (1).
(5) Is a psychologist and meets one of the following requirements:
(A) Is board certified in clinical psychology by a board
recognized by the administrative director.
(B) Holds a doctoral degree in psychology, or a doctoral degree
deemed equivalent for licensure by the Board of Psychology pursuant
to Section 2914 of the Business and Professions Code, from a
university or professional school recognized by the administrative
director and has not less than five years' postdoctoral experience in
the diagnosis and treatment of emotional and mental disorders.
(C) Has not less than five years' postdoctoral experience in the
diagnosis and treatment of emotional and mental disorders, and has
served as an agreed medical evaluator on eight or more occasions
prior to January 1, 1990.
(6) Is a practicing clinical audiologist licensed by the State of
California who meets all of the following requirements:
(A) Holds a doctorate of audiology (Au.D.) or a Ph.D., or both, in
an audiology-related profession and is licensed by the
Speech-Language Pathology and Audiology and Hearing Aid Dispensers
Board pursuant to Article 3 (commencing with Section 2532) of Chapter
5.3 of Division 2 of the Business and Professions Code, from a
university training program recognized by the board.
(B) Has not less than five years' postdoctoral experience in the
practice of audiology.
(C) Prior to his or her appointment as a qualified medical
evaluator, passed the same examination described in paragraph (1) for
the purpose of demonstrating competence in evaluating medical-legal
issues in the workers' compensation system.
(D) When acting as a qualified medical evaluator, bases the
diagnosis portion of the qualified medical evaluator report on the
diagnosis made by a physician who is licensed in the state to
practice medicine.
(6)
(7) Does not have a conflict of interest as determined
under the regulations adopted by the administrative director pursuant
to subdivision (o).
(7)
(8) Meets any additional medical or professional
standards adopted pursuant to paragraph (6) of subdivision (j).
(c) The administrative director shall adopt standards for
appointment of physicians who are retired or who hold teaching
positions who are exceptionally well qualified to serve as a
qualified medical evaluator even though they do not otherwise qualify
under paragraph (2) of subdivision (b). In no event shall a
physician whose full-time practice is limited to the forensic
evaluation of disability be appointed as a qualified medical
evaluator under this subdivision.
(d) The qualified medical evaluator, upon request, shall be
reappointed if he or she meets the qualifications of subdivision (b)
and meets all of the following criteria:
(1) Is in compliance with all applicable regulations and
evaluation guidelines adopted by the administrative director.
(2) Has not had more than five of his or her evaluations that were
considered by a workers' compensation administrative law judge at a
contested hearing rejected by the workers' compensation
administrative law judge or the appeals board pursuant to this
section during the most recent two-year period during which the
physician served as a qualified medical evaluator. If the workers'
compensation administrative law judge or the appeals board rejects
the qualified medical evaluator's report on the basis that it fails
to meet the minimum standards for those reports established by the
administrative director or the appeals board, the workers'
compensation administrative law judge or the appeals board, as the
case may be, shall make a specific finding to that effect, and shall
give notice to the medical evaluator and to the administrative
director. Any rejection shall not be counted as one of the five
qualifying rejections until the specific finding has become final and
time for appeal has expired.
(3) Has completed within the previous 24 months at least 12 hours
of continuing education in impairment evaluation or workers'
compensation-related medical dispute evaluation approved by the
administrative director.
(4) Has not been terminated, suspended, placed on probation, or
otherwise disciplined by the administrative director during his or
her most recent term as a qualified medical evaluator.
If the evaluator does not meet any one of these criteria, the
administrative director may in his or her discretion reappoint or
deny reappointment according to regulations adopted by the
administrative director. In no event may a A
physician who does not currently meet the requirements for
initial appointment or who has been terminated under subdivision (e)
because his or her license has been revoked or terminated by the
licensing authority shall not be reappointed.
(e) The administrative director may, in his or her discretion,
suspend or terminate a qualified medical evaluator during his or her
term of appointment without a hearing as provided under subdivision
(k) or (l) whenever either of the following conditions occurs:
(1) The evaluator's license to practice in California has been
suspended by the relevant licensing authority so as to preclude
practice, or has been revoked or terminated by the licensing
authority.
(2) The evaluator has failed to timely pay the fee required by the
administrative director pursuant to subdivision (n).
(f) The administrative director shall furnish a physician, upon
request, with a written statement of its reasons for termination of,
or for denying appointment or reappointment as, a qualified medical
evaluator. Upon receipt of a specific response to the statement of
reasons, the administrative director shall review his or her decision
not to appoint or reappoint the physician or to terminate the
physician and shall notify the physician of its final decision within
60 days after receipt of the physician's response.
(g) The administrative director shall establish agreements with
qualified medical evaluators to assure the expeditious evaluation of
cases assigned to them for comprehensive medical evaluations.
(h) (1) When requested by an employee or employer pursuant to
Section 4062.1, the medical director appointed pursuant to Section
122 shall assign a three-member panels
panel of qualified medical evaluators within five working
days after receiving a request for a panel. If a panel is not
assigned within 15 working days, the employee shall have the right to
obtain a medical evaluation from any qualified medical evaluator of
his or her choice. The medical director shall use a random selection
method for assigning panels of qualified medical evaluators. The
medical director shall select evaluators who are specialists of the
type requested by the employee. The medical director shall advise the
employee that he or she should consult with his or her treating
physician prior to deciding which type of specialist to request.
(2) The administrative director shall promulgate a form that shall
notify the employee of the physicians selected for his or her panel
after a request has been made pursuant to Section 4062.1 or 4062.2.
The form shall include, for each physician on the panel, the
physician's name, address, telephone number, specialty, number of
years in practice, and a brief description of his or her education
and training, and shall advise the employee that he or she is
entitled to receive transportation expenses and temporary disability
for each day necessary for the examination. The form shall also state
in a clear and conspicuous location and type: "You have the right to
consult with an information and assistance officer at no cost to you
prior to selecting the doctor to prepare your evaluation, or you may
consult with an attorney. If your claim eventually goes to court,
the workers' compensation administrative law judge will consider the
evaluation prepared by the doctor you select to decide your claim."
(3) When compiling the list of evaluators from which to select
randomly, the medical director shall include all qualified medical
evaluators who meet all of the following criteria:
(A) He or she does not have a conflict of interest in the case, as
defined by regulations adopted pursuant to subdivision (o).
(B) He or she is certified by the administrative director to
evaluate in an appropriate specialty and at locations within the
general geographic area of the employee's residence.
(C) He or she has not been suspended or terminated as a qualified
medical evaluator for failure to pay the fee required by the
administrative director pursuant to subdivision (n) or for any other
reason.
(4) When the medical director determines that an employee has
requested an evaluation by a type of specialist that is appropriate
for the employee's injury, but there are not enough qualified medical
evaluators of that type within the general geographic area of the
employee's residence to establish a three-member panel, the medical
director shall include sufficient qualified medical evaluators from
other geographic areas and the employer shall pay all necessary
travel costs incurred in the event the employee selects an evaluator
from another geographic area.
(i) The medical director appointed pursuant to Section 122 shall
continuously review the quality of comprehensive medical evaluations
and reports prepared by agreed and qualified medical evaluators and
the timeliness with which evaluation reports are prepared and
submitted. The review shall include, but not be limited to, a review
of a random sample of reports submitted to the division, and a review
of all reports alleged to be inaccurate or incomplete by a party to
a case for which the evaluation was prepared. The medical director
shall submit to the administrative director an annual report
summarizing the results of the continuous review of medical
evaluations and reports prepared by agreed and qualified medical
evaluators and make recommendations for the improvement of the system
of medical evaluations and determinations.
(j) After public hearing pursuant to Section 5307.3, the
administrative director shall adopt regulations concerning the
following issues:
(1) (A) Standards governing the timeframes within which medical
evaluations shall be prepared and submitted by agreed and qualified
medical evaluators. Except as provided in this subdivision, the
timeframe for initial medical evaluations to be prepared and
submitted shall be no more than 30 days after the evaluator has seen
the employee or otherwise commenced the medical evaluation procedure.
The administrative director shall develop regulations governing the
provision of extensions of the 30-day period in both of the following
cases:
(i) When the evaluator has not received test results or consulting
physician's evaluations in time to meet the 30-day deadline.
(ii) To extend the 30-day period by not more than 15 days when the
failure to meet the 30-day deadline was for good cause.
(B) For purposes of subparagraph (A), "good cause" means any of
the following:
(i) Medical emergencies of the evaluator or evaluator's family.
(ii) Death in the evaluator's family.
(iii) Natural disasters or other community catastrophes that
interrupt the operation of the evaluator's business.
(C) The administrative director shall develop timeframes governing
availability of qualified medical evaluators for unrepresented
employees under Sections 4061 and 4062. These timeframes shall give
the employee the right to the addition of a new evaluator to his or
her panel, selected at random, for each evaluator not available to
see the employee within a specified period of time, but shall also
permit the employee to waive this right for a specified period of
time thereafter.
(2) Procedures to be followed by all physicians in evaluating the
existence and extent of permanent impairment and limitations
resulting from an injury in a manner consistent with Section 4660.
(3) Procedures governing the determination of any disputed medical
treatment issues in a manner consistent with Section 5307.27.
(4) Procedures to be used in determining the compensability of
psychiatric injury. The procedures shall be in accordance with
Section 3208.3 and shall require that the diagnosis of a mental
disorder be expressed using the terminology and criteria of the
American Psychiatric Association's Diagnostic and Statistical Manual
of Mental Disorders, Third Edition-Revised, or the terminology and
diagnostic criteria of other psychiatric diagnostic manuals generally
approved and accepted nationally by practitioners in the field of
psychiatric medicine.
(5) Guidelines for the range of time normally required to perform
the following:
(A) A medical-legal evaluation that has not been defined and
valued pursuant to Section 5307.6. The guidelines shall establish
minimum times for patient contact in the conduct of the evaluations,
and shall be consistent with regulations adopted pursuant to Section
5307.6.
(B) Any treatment procedures that have not been defined and valued
pursuant to Section 5307.1.
(C) Any other evaluation procedure requested by the Insurance
Commissioner, or deemed appropriate by the administrative director.
(6) Any additional medical or professional standards that a
medical evaluator shall meet as a condition of appointment,
reappointment, or maintenance in the status of a medical evaluator.
(k) Except as provided in this subdivision, the administrative
director may, in his or her discretion, suspend or terminate the
privilege of a physician to serve as a qualified medical evaluator if
the administrative director, after hearing pursuant to subdivision (
l ), determines, based on substantial evidence, that a
qualified medical evaluator:
(1) Has violated any material statutory or administrative duty.
(2) Has failed to follow the medical procedures or qualifications
established pursuant to paragraph (2), (3), (4), or (5) of
subdivision (j).
(3) Has failed to comply with the timeframe standards established
pursuant to subdivision (j).
(4) Has failed to meet the requirements of subdivision (b) or (c).
(5) Has prepared medical-legal evaluations that fail to meet the
minimum standards for those reports established by the administrative
director or the appeals board.
(6) Has made material misrepresentations or false statements in an
application for appointment or reappointment as a qualified medical
evaluator.
No hearing shall be required prior to the suspension or
termination of a physician's privilege to serve as a qualified
medical evaluator when the physician has done either of the
following:
(A) Failed to timely pay the fee required pursuant to subdivision
(n).
(B) Had his or her license to practice in California suspended by
the relevant licensing authority so as to preclude practice, or had
the license revoked or terminated by the licensing authority.
( l ) The administrative director shall cite the
qualified medical evaluator for a violation listed in subdivision (k)
and shall set a hearing on the alleged violation within 30 days of
service of the citation on the qualified medical evaluator. In
addition to the authority to terminate or suspend the qualified
medical evaluator upon finding a violation listed in subdivision (k),
the administrative director may, in his or her discretion, place a
qualified medical evaluator on probation subject to appropriate
conditions, including ordering continuing education or training. The
administrative director shall report to the appropriate licensing
board the name of any qualified medical evaluator who is disciplined
pursuant to this subdivision.
(m) The administrative director shall terminate from the list of
medical evaluators any physician where licensure has been terminated
by the relevant licensing board, or who has been convicted of a
misdemeanor or felony related to the conduct of his or her medical
practice, or of a crime of moral turpitude. The administrative
director shall suspend or terminate as a medical evaluator any
physician who has been suspended or placed on probation by the
relevant licensing board. If a physician is suspended or terminated
as a qualified medical evaluator under this subdivision, a report
prepared by the physician that is not complete, signed, and furnished
to one or more of the parties prior to the date of conviction or
action of the licensing board, whichever is earlier, shall not be
admissible in any proceeding before the appeals board nor shall there
be any liability for payment for the report and any expense incurred
by the physician in connection with the report.
(n) Each qualified medical evaluator shall pay a fee, as
determined by the administrative director, for appointment or
reappointment. These fees shall be based on a sliding scale as
established by the administrative director. All revenues from fees
paid under this subdivision shall be deposited into the Workers'
Compensation Administration Revolving Fund and are available for
expenditure upon appropriation by the Legislature, and shall not be
used by any other department or agency or for any purpose other than
administration of the programs the Division of Workers' Compensation
related to the provision of medical treatment to injured employees.
(o) An evaluator may not request or accept any compensation or
other thing of value from any source that does or could create a
conflict with his or her duties as an evaluator under this code. The
administrative director, after consultation with the Commission on
Health and Safety and Workers' Compensation, shall adopt regulations
to implement this subdivision.
SEC. 2. Section 3209.3 of the Labor Code is amended to read:
3209.3. (a) "Physician" includes physicians and surgeons holding
an M.D. or D.O. degree, psychologists, acupuncturists, optometrists,
dentists, podiatrists, audiologists, and chiropractic
practitioners licensed by California state law and within the scope
of their practice as defined by California state law.
(b) (1) "Psychologist" means a licensed
psychologist with a doctoral degree in psychology, or a doctoral
degree deemed equivalent for licensure by the Board of Psychology
pursuant to Section 2914 of the Business and Professions Code, and
who either has at least two years of clinical experience in a
recognized health setting or has met the standards of the National
Register of the Health Service Providers in Psychology.
(c)
(2) When treatment or evaluation for an injury is
provided by a psychologist, provision shall be made for appropriate
medical collaboration when requested by the employer or the insurer.
(d)
(c) (1) "Acupuncturist" means a
person who holds an acupuncturist's certificate issued pursuant to
Chapter 12 (commencing with Section 4925) of Division 2 of the
Business and Professions Code.
(e)
(2) Nothing in this section shall be construed to
authorize acupuncturists to determine disability for the purposes of
Article 3 (commencing with Section 4650) of Chapter 2 of Part 2, or
under Section 2708 of the Unemployment Insurance Code.
(d) (1) "Audiologist" means a person licensed as an audiologist
pursuant to Article 3 (commencing with Section 2532) of Chapter 5.3
of Division 2 of the Business and Professions Code and holds a
doctorate of audiology (Au.D.) or a Ph.D. degree in an
audiology-related profession.
(2) The inclusion of audiologists in this section shall not imply
any right or entitle any audiologist to represent, advertise, or hold
himself or herself out as a physician.