BILL NUMBER: SB 1105 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY AUGUST 24, 2012
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.
This bill would incorporate additional changes in Section 4903.1
of the Labor Code proposed by SB 863 that would become operative only
if SB 863 and this bill are both chaptered and become effective on
or before January 1, 2013, and this bill is chaptered last.
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. 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 or self-insured employee welfare benefit
plan 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.
SEC. 1.5. 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) Section 4903.05 , 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 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)
(a) 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)
(b) 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)
(c) (1) 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. Such
loss-of-time benefits and for benefits paid by a self-insured
employee welfare benefit plan. The 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
A lien shall not be allowed hereunder unless
the group disability policy or self-insured employee welfare
benefit plan provides for reduction, exclusion, or coordination
of loss of time loss-of-time benefits
on account of workers' compensation benefits.
(2) For purposes of this subdivision, "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:
(A) Medical, surgical, or hospital care benefits.
(B) Monetary or other benefits in the event of sickness, accident,
disability, death, or unemployment.
(4)
(d) 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.
SEC. 2. Section 1.5 of this bill incorporates all
of the substantive amendments to Section 4903.1 of the Labor Code
proposed by both this bill and Senate Bill 863. It shall only become
operative if (1) both bills are enacted and become effective on or
before January 1, 2013, (2) each bill amends Section 4903.1 of the
Labor Code, and (3) this bill is enacted after Senate Bill 863, in
which case Section 1 of this bill shall not become operative.