BILL NUMBER: AB 1687	ENROLLED
	BILL TEXT

	PASSED THE SENATE  AUGUST 29, 2012
	PASSED THE ASSEMBLY  AUGUST 30, 2012
	AMENDED IN SENATE  JUNE 18, 2012
	AMENDED IN SENATE  JUNE 6, 2012
	AMENDED IN ASSEMBLY  MARCH 12, 2012

INTRODUCED BY   Assembly Member Fong

                        FEBRUARY 14, 2012

   An act to amend Section 138.4 of, and to add Section 4610.2 to,
the Labor Code, relating to workers' compensation.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 1687, Fong. Workers' compensation.
   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 his or her employment. Existing law
requires every employer to establish a utilization review process,
either directly or through its insurer or an entity with which an
employer contracts for these services, for the purpose of reviewing
and approving, modifying, delaying, or denying treatment
recommendations made by physicians with respect to injured workers.
Existing law requires that the administrative director, in
consultation with the Commission on Health and Safety and Workers'
Compensation, prescribe rules and regulations for serving notices
that contain specified information on employees.
   This bill would add information regarding objections to decisions
based on utilization reviews to those prescribed notices.
   Under existing law, when a party to a proceeding institutes
proceedings to terminate an award made by the Workers' Compensation
Appeals Board for continuing medical treatment and is unsuccessful in
these proceedings, the appeals board is authorized to award
reasonable attorney's fees to an applicant resisting these
proceedings.
   This bill would authorize the appeals board to award attorney's
fees reasonably incurred by an applicant who prevails in a proceeding
in connection with the enforcement of a final award of permanent
disability following a medical dispute that arises in the course of
the utilization review process.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 138.4 of the Labor Code is amended to read:
   138.4.  (a) For the purpose of this section, "claims administrator"
means a self-administered workers' compensation insurer; or a
self-administered self-insured employer; or a self-administered
legally uninsured employer; or a self-administered joint powers
authority; or a third-party claims administrator for an insurer, a
self-insured employer, a legally uninsured employer, or a joint
powers authority.
   (b) With respect to injuries resulting in lost time beyond the
employee's work shift at the time of injury or medical treatment
beyond first aid:
   (1) If the claims administrator obtains knowledge that the
employer has not provided a claim form or a notice of potential
eligibility for benefits to the employee, it shall provide the form
and notice to the employee within three working days of its knowledge
that the form or notice was not provided.
   (2) If the claims administrator cannot determine if the employer
has provided a claim form and notice of potential eligibility for
benefits to the employee, the claims administrator shall provide the
form and notice to the employee within 30 days of the administrator's
date of knowledge of the claim.
   (c) The administrative director, in consultation with the
Commission on Health and Safety and Workers' Compensation, shall
prescribe reasonable rules and regulations, including notice of the
right to consult with an attorney, where appropriate, for serving on
the employee (or employee's dependents, in the case of death), the
following:
   (1) Notices dealing with the payment, nonpayment, or delay in
payment of temporary disability, permanent disability, supplemental
job displacement, and death benefits.
   (2) Notices of any change in the amount or type of benefits being
provided, the termination of benefits, the rejection of any liability
for compensation, and an accounting of benefits paid.
   (3) Notices of rights to select the primary treating physician,
written continuity of care policies, requests for a comprehensive
medical evaluation, explanations of the options available to object
to a decision made pursuant to the utilization review process, as
described in Section 4610, to modify, delay, or deny medical
treatment, and offers of regular, modified, or alternative work.
   (d) The administrative director, in consultation with the
Commission on Health and Safety and Workers' Compensation, shall
develop, make fully accessible on the department's Internet Web site,
and make available at district offices informational material
written in plain language that describes the overall workers'
compensation claims process, including the rights and obligations of
employees and employers at every stage of a claim when a notice is
required.
   (e) Each notice prescribed by the administrative director shall be
written in plain language, shall reference the informational
material described in subdivision (d) to enable employees to
understand the context of the notices, and shall clearly state the
Internet Web site address and contact information that an employee
may use to access the informational material.
  SEC. 2.  Section 4610.2 is added to the Labor Code, to read:
   4610.2.  If a final award of permanent disability made by the
appeals board specifies the provision of future medical treatment and
a medical dispute arises in the course of a utilization review
conducted pursuant to Section 4610 in connection with the enforcement
of this award, and the applicant employs an attorney for purposes of
enforcing the award and prevails, the appeals board may award
attorney's fees reasonably incurred by the applicant in connection
with enforcement of the award.