BILL NUMBER: SB 1105	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  JUNE 13, 2012
	AMENDED IN SENATE  MAY 2, 2012
	AMENDED IN SENATE  APRIL 16, 2012

INTRODUCED BY   Senator Lieu

                        FEBRUARY 16, 2012

   An act to amend Section 4903.1 of the Labor Code, relating to
workers' compensation.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 1105, as amended, Lieu. Workers' compensation: liens.
   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 workers'
compensation law authorizes the Workers' Compensation Appeals Board
to determine and allow specified expenses as liens against any sum to
be paid as compensation. Existing law requires, before issuing an
award or approval of any compromise of claim, the determination of
whether any benefits have been paid or services provided by specified
entities.
   This bill would require the appeals board to allow a lien for 
loss-of-time  benefits paid by a self-insured employee welfare
benefit plan, as defined.
   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 4903.1 of the Labor Code is amended to read:
   4903.1.  (a) The appeals board, arbitrator, or settlement
conference referee, before issuing an award or approval of any
compromise of claim, shall determine, on the basis of liens filed
with it pursuant to subdivision (b) or (c), whether any benefits have
been paid or services provided by a health care provider, a health
care service plan, a group disability policy, including a
loss-of-income policy, a self-insured employee welfare benefit plan,
or a hospital service contract, and its award or approval shall
provide for reimbursement for benefits paid or services provided
under these plans as follows:
   (1) When the referee issues an award finding that an injury or
illness arises out of and in the course of employment, but denies the
applicant reimbursement for self-procured medical costs solely
because of lack of notice to the applicant's employer of his or her
need for hospital, surgical, or medical care, the appeals board shall
nevertheless award a lien against the employee's recovery, to the
extent of benefits paid or services provided, for the effects of the
industrial injury or illness, by a health care provider, a health
care service plan, a group disability policy, a self-insured employee
welfare benefit plan, or a hospital service contract.
   (2) When the referee issues an award finding that an injury or
illness arises out of and in the course of employment, and makes an
award for reimbursement for self-procured medical costs, the appeals
board shall allow a lien, to the extent of benefits paid or services
provided, for the effects of the industrial injury or illness, by a
health care provider, a health care service plan, a group disability
policy, a self-insured employee welfare benefit plan, or a hospital
service contract. For purposes of this paragraph, benefits paid or
services provided by a self-insured employee welfare benefit plan
shall be determined notwithstanding the official medical fee schedule
adopted pursuant to Section 5307.1.
   (3)  (A)    When the referee issues an award
finding that an injury or illness arises out of and in the course of
employment and makes an award for temporary disability indemnity, the
appeals board shall allow a lien as living expense under Section
4903, for benefits paid by a group disability policy providing
loss-of-time benefits and for  loss-of-time  benefits paid
by a self-insured employee welfare benefit plan  , as defined
in subdivision (f) of Section 10121 of the Insurance Code 
. Such lien shall be allowed to the extent that benefits have been
paid for the same day or days for which temporary disability
indemnity is awarded and shall not exceed the award for temporary
disability indemnity. No lien shall be allowed hereunder unless the
group disability policy provides for reduction, exclusion, or
coordination of loss-of-time benefits on account of workers'
compensation benefits. 
   (B) For purposes of this paragraph, "self-insured employee welfare
benefit plan" means any plan, fund, or program that is established
or maintained by an employer or by an employee organization, or by
both, to the extent that the plan, fund, or program was established
or is maintained for the purpose of providing for its participants or
their beneficiaries, other than through the purchase of insurance,
either of the following:  
   (i) Medical, surgical, or hospital care or benefits.  
   (ii) Monetary or other benefits in the event of sickness,
accident, disability, death, or unemployment. 
   (4) When the parties propose that the case be disposed of by way
of a compromise and release agreement, in the event the lien
claimant, other than a health care provider, does not agree to the
amount allocated to it, then the referee shall determine the
potential recovery and reduce the amount of the lien in the ratio of
the applicant's recovery to the potential recovery in full
satisfaction of its lien claim.
   (b) When a compromise of claim or an award is submitted to the
appeals board, arbitrator, or settlement conference referee for
approval, the parties shall file with the appeals board, arbitrator,
or settlement conference referee any liens served on the parties.
   (c) Any lien claimant under Section 4903 or this section shall
file its lien with the appeals board in writing upon a form approved
by the appeals board. The lien shall be accompanied by a full
statement or itemized voucher supporting the lien and justifying the
right to reimbursement and proof of service upon the injured worker,
or if deceased, upon the worker's dependents, the employer, the
insurer, and the respective attorneys or other agents of record.
   (d) The appeals board shall file liens required by subdivision (c)
immediately upon receipt. Numbers shall be assigned pursuant to
subdivision (c) of Section 5500.
   (e) The changes made to this section by Senate Bill 457 of the
2011-12 Regular Session do not modify in any way the rights or
obligations of the following:
   (1) Any health care provider to file and prosecute a lien pursuant
to subdivision (b) of Section 4903.
   (2) A payor to conduct utilization review pursuant to Section
4610.
   (3) Any party in complying with the requirements under Section
4903.