Amended in Assembly August 30, 2013

Amended in Senate May 2, 2013

Amended in Senate March 19, 2013

Senate Bill No. 258

Introduced by Senator Lieu

February 13, 2013

An act to amend Sections 112 begin delete and end delete begin insert , 4600, 4903.07, end insert 4903.8 begin insert , and 5410 end insert of the Labor Code, relating to workers’ compensation.

LEGISLATIVE COUNSEL’S DIGEST

SB 258, as amended, Lieu. Workers’ compensation.

Existing law establishes the 7-member Workers’ Compensation Appeals Board, and provides that the members of the appeals board are appointed by the Governor with the advice and consent of the Senate. Existing law requires that 5 of the 7 members of the board be experienced attorneys admitted to practice in the State of California, and provides that the other 2 members need not be attorneys.

This bill would require that all 7 members of the board be experienced attorneys admitted to practice in the State of California.

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 begin insert law requires that medical, surgical, chiropractic, acupuncture, and hospital treatment that is reasonably required to relieve the injured worker from the effects of his or her injury be provided by the employer. Existing law prohibits a chiropractor from being a treating physician after the employee has received a certain number of chiropractic visits. end insert

begin insert

This bill would correct an erroneous cross-reference with respect to these provisions.

end insert begin insert

Existing law requires that a lien claimant is entitled to an order or award for reimbursement of a lien filing fee or lien activation fee, together with interest at the rate allowed on civil judgments, if certain conditions are satisfied.

end insert begin insert

This bill would specify that these fees are to be paid by the employer.

end insert

begin insert Existing end insert law requires an order or award for payment of a lien for medical or hospital treatment, as specified, to be made for payment only to the person who was entitled to payment for the expenses for medical or hospital treatment at the time the expenses were incurred, and not to an assignee unless the person has ceased doing business in the capacity held at the time the expenses were incurred and has assigned all right, title, and interest in the remaining accounts receivable to the assignee.

This bill would authorize an assignment of that payment if the assignment was completed prior to January 1, 2013, or if it was required by a contract that became enforceable and irrevocable prior to January 1, 2013. The bill would state that this provision is declarative of existing law.

begin insert

Existing law authorizes an injured worker to institute proceedings for the collection of compensation, including vocational rehabilitation services, within 5 years after the date of the injury upon the ground that the original injury has caused new and further disability or that providing vocational rehabilitation services has become feasible because the employee’s medical condition has improved or because of other factors not capable of determination at the time the employer’s liability for vocational rehabilitation services otherwise terminated.

end insert begin insert

This bill would delete the provisions relating to vocational rehabilitation, but retain the authority of an injured worker to institute proceedings for the collection of compensation within 5 years after the date of the injury upon the ground that the original injury has caused new and further disability.

end insert

Vote: majority. Appropriation: no. Fiscal committee: no. State-mandated local program: no.

The people of the State of California do enact as follows:

SECTION 1.  

Section 112 of the Labor Code is amended to
read:

112.  

(a) The members of the appeals board shall be appointed
by the Governor with the advice and consent of the Senate. The
term of office of the members appointed prior to January 1, 1990,
shall be four years, and the term of office of members appointed
on or after January 1, 1990, shall be six years and they shall hold
office until the appointment and qualification of their successors.

(b) All of the members of the appeals board shall be experienced
attorneys at law admitted to practice in the State of California. All
members shall be selected with due consideration of their judicial
temperament and abilities. Each member shall receive the salary
provided for by Chapter 6 (commencing with Section 11550) of
Part 1 of Division 3 of Title 2 of the Government Code.

begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 4600 of the end insert begin insert Labor Code end insert begin insert is amended to read: end insert

4600.  

(a) Medical, surgical, chiropractic, acupuncture, and
hospital treatment, including nursing, medicines, medical and
surgical supplies, crutches, and apparatuses, including orthotic and
prosthetic devices and services, that is reasonably required to cure
or relieve the injured worker from the effects of his or her injury
shall be provided by the employer. In the case of his or her neglect
or refusal reasonably to do so, the employer is liable for the
reasonable expense incurred by or on behalf of the employee in
providing treatment.

(b) As used in this division and notwithstanding any other
provision of law, medical treatment that is reasonably required to
cure or relieve the injured worker from the effects of his or her
injury means treatment that is based upon the guidelines adopted
by the administrative director pursuant to Section 5307.27.

(c) Unless the employer or the employer’s insurer has
established or contracted with a medical provider network as
provided for in Section 4616, after 30 days from the date the injury
is reported, the employee may be treated by a physician of his or
her own choice or at a facility of his or her own choice within a
reasonable geographic area. A chiropractor shall not be a treating
physician after the employee has received the maximum number
of chiropractic visits allowed by subdivision begin delete (d) end delete begin insert (c) end insert of Section
4604.5.

(d) (1) If an employee has notified his or her employer in
writing prior to the date of injury that he or she has a personal
physician, the employee shall have the right to be treated by that
physician from the date of injury if the employee has health care
coverage for nonoccupational injuries or illnesses on the date of
injury in a plan, policy, or fund as described in subdivisions (b),
(c), and (d) of Section 4616.7.

(2) For purposes of paragraph (1), a personal physician shall
meet all of the following conditions:

(A) Be the employee’s regular physician and surgeon, licensed
pursuant to Chapter 5 (commencing with Section 2000) of Division
2 of the Business and Professions Code.

(B) Be the employee’s primary care physician and has
previously directed the medical treatment of the employee, and
who retains the employee’s medical records, including his or her
medical history. “Personal physician” includes a medical group,
if the medical group is a single corporation or partnership
composed of licensed doctors of medicine or osteopathy, which
operates an integrated multispecialty medical group providing
comprehensive medical services predominantly for
nonoccupational illnesses and injuries.

(C) The physician agrees to be predesignated.

(3) If the employee has health care coverage for nonoccupational
injuries or illnesses on the date of injury in a health care service
plan licensed pursuant to Chapter 2.2 (commencing with Section
1340) of Division 2 of the Health and Safety Code, and the
employer is notified pursuant to paragraph (1), all medical
treatment, utilization review of medical treatment, access to
medical treatment, and other medical treatment issues shall be
governed by Chapter 2.2 (commencing with Section 1340) of
Division 2 of the Health and Safety Code. Disputes regarding the
provision of medical treatment shall be resolved pursuant to Article
5.55 (commencing with Section 1374.30) of Chapter 2.2 of
Division 2 of the Health and Safety Code.

(4) If the employee has health care coverage for nonoccupational
injuries or illnesses on the date of injury in a group health insurance
policy as described in Section 4616.7, all medical treatment,
utilization review of medical treatment, access to medical
treatment, and other medical treatment issues shall be governed
by the applicable provisions of the Insurance Code.

(5) The insurer may require prior authorization of any
nonemergency treatment or diagnostic service and may conduct
reasonably necessary utilization review pursuant to Section 4610.

(6) An employee shall be entitled to all medically appropriate
referrals by the personal physician to other physicians or medical
providers within the nonoccupational health care plan. An
employee shall be entitled to treatment by physicians or other
medical providers outside of the nonoccupational health care plan
pursuant to standards established in Article 5 (commencing with
Section 1367) of Chapter 2.2 of Division 2 of the Health and Safety
Code.

(e) (1) When at the request of the employer, the employer’s
insurer, the administrative director, the appeals board, or a workers’
compensation administrative law judge, the employee submits to
examination by a physician, he or she shall be entitled to receive,
in addition to all other benefits herein provided, all reasonable
expenses of transportation, meals, and lodging incident to reporting
for the examination, together with one day of temporary disability
indemnity for each day of wages lost in submitting to the
examination.

(2) Regardless of the date of injury, “reasonable expenses of
transportation” includes mileage fees from the employee’s home
to the place of the examination and back at the rate of twenty-one
cents ($0.21) a mile or the mileage rate adopted by the Director
of Human Resources pursuant to Section 19820 of the Government
Code, whichever is higher, plus any bridge tolls. The mileage and
tolls shall be paid to the employee at the time he or she is given
notification of the time and place of the examination.

(f) When at the request of the employer, the employer’s insurer,
the administrative director, the appeals board, or a workers’
compensation administrative law judge, an employee submits to
examination by a physician and the employee does not proficiently
speak or understand the English language, he or she shall be
entitled to the services of a qualified interpreter in accordance with
conditions and a fee schedule prescribed by the administrative
director. These services shall be provided by the employer. For
purposes of this section, “qualified interpreter” means a language
interpreter certified, or deemed certified, pursuant to Article 8
(commencing with Section 11435.05) of Chapter 4.5 of Part 1 of
Division 3 of Title 2 of, or Section 68566 of, the Government
Code.

(g) If the injured employee cannot effectively communicate
with his or her treating physician because he or she cannot
proficiently speak or understand the English language, the injured
employee is entitled to the services of a qualified interpreter during
medical treatment appointments. To be a qualified interpreter for
purposes of medical treatment appointments, an interpreter is not
required to meet the requirements of subdivision (f), but shall meet
any requirements established by rule by the administrative director
that are substantially similar to the requirements set forth in Section
1367.04 of the Health and Safety Code. The administrative director
shall adopt a fee schedule for qualified interpreter fees in
accordance with this section. Upon request of the injured employee,
the employer or insurance carrier shall pay for interpreter services.
An employer shall not be required to pay for the services of an
interpreter who is not certified or is provisionally certified by the
person conducting the medical treatment or examination unless
either the employer consents in advance to the selection of the
individual who provides the interpreting service or the injured
worker requires interpreting service in a language other than the
languages designated pursuant to Section 11435.40 of the
Government Code.

(h) Home health care services shall be provided as medical
treatment only if reasonably required to cure or relieve the injured
employee from the effects of his or her injury and prescribed by
a physician and surgeon licensed pursuant to Chapter 5
(commencing with Section 2000) of Division 2 of the Business
and Professions Code, and subject to Section 5307.1 or 5703.8.
The employer shall not be liable for home health care services that
are provided more than 14 days prior to the date of the employer’s
receipt of the physician’s prescription.

begin insert

begin insert SEC. 3. end insert   

end insert

begin insert Section 4903.07 of the end insert begin insert Labor Code end insert begin insert is amended to read: end insert

4903.07.  

(a) A lien claimant shall be entitled to an order or
award for reimbursement begin insert from the employer end insert of a lien filing fee or
lien activation fee, together with interest at the rate allowed on
civil judgments, only if all of the following conditions are satisfied:

(1) Not less than 30 days before filing the lien for which the
filing fee was paid or filing the declaration of readiness for which
the lien activation fee was paid, the lien claimant has made written
demand for settlement of the lien claim for a clearly stated sum
which shall be inclusive of all claims of debt, interest, penalty, or
other claims potentially recoverable on the lien.

(2) The defendant fails to accept the settlement demand in
writing within 20 days of receipt of the demand for settlement, or
within any additional time as may be provide by the written
demand.

(3) After submission of the lien dispute to the appeals board or
an arbitrator, a final award is made in favor of the lien claimant
of a specified sum that is equal to or greater than the amount of
the settlement demand. The amount of the interest and filing fee
or lien activation fee shall not be considered in determining whether
the award is equal to or greater than the demand.

(b) This section shall not preclude an order or award of
reimbursement of the filing fee or activation fee pursuant to the
express terms of an agreed disposition of a lien dispute.

begin delete SEC. 2. end delete
begin insert SEC. 4. end insert   

Section 4903.8 of the Labor Code is amended to read:

4903.8.  

(a) (1) Any order or award for payment of a lien filed
pursuant to subdivision (b) of Section 4903 shall be made for
payment only to the person who was entitled to payment for the
expenses as provided in subdivision (b) of Section 4903 at the time
the expenses were incurred, and not to an assignee unless the
person has ceased doing business in the capacity held at the time
the expenses were incurred and has assigned all right, title, and
interest in the remaining accounts receivable to the assignee.

(2) Paragraph (1) does not apply to an assignment that was
completed prior to January 1, 2013, or that was required by a
contract that became enforceable and irrevocable prior to January
1, 2013. This paragraph is declarative of existing law.

(b) If there has been an assignment of a lien, either as an
assignment of all right, title, and interest in the accounts receivable
or as an assignment for collection, a true and correct copy of the
assignment shall be filed and served.

(1) If the lien is filed on or after January 1, 2013, and the
assignment occurs before the filing of the lien, the copy of the
assignment shall be served at the time the lien is filed.

(2) If the lien is filed on or after January 1, 2013, and the
assignment occurs after the filing of the lien, the copy of the
assignment shall be served within 20 days of the date of the
assignment.

(3) If the lien is filed before January 1, 2013, the copy of the
assignment shall be served by January 1, 2014, or with the filing
of a declaration of readiness or at the time of a lien hearing,
whichever is earliest.

(c) If there has been more than one assignment of the same
receivable or bill, the appeals board may set the matter for hearing
on whether the multiple assignments constitute bad-faith actions
or tactics that are frivolous, harassing, or intended to cause
unnecessary delay or expense. If so found by the appeals board,
appropriate sanctions, including costs and attorney’s fees, may be
awarded against the assignor, assignee, and their respective
attorneys.

(d) At the time of filing of a lien on or after January 1, 2013, or
in the case of a lien filed before January 1, 2013, at the earliest of
the filing of a declaration of readiness, a lien hearing, or January
1, 2014, supporting documentation shall be filed including one or
more declarations under penalty of perjury by a natural person or
persons competent to testify to the facts stated, declaring both of
the following:

(1) The services or products described in the bill for services
or products were actually provided to the injured employee.

(2) The billing statement attached to the lien truly and accurately
describes the services or products that were provided to the injured
employee.

(e) A lien submitted for filing on or after January 1, 2013, for
expenses provided in subdivision (b) of Section 4903, that does
not comply with the requirements of this section shall be deemed
to be invalid, whether or not accepted for filing by the appeals
board, and shall not operate to preserve or extend any time limit
for filing of the lien.

(f) This section shall take effect without regulatory action. The
appeals board and the administrative director may promulgate
regulations and forms for the implementation of this section.

begin insert

begin insert SEC. 5. end insert   

end insert

begin insert Section 5410 of the end insert begin insert Labor Code end insert begin insert is amended to read: end insert

5410.  

Nothing in this chapter shall bar the right of any injured
worker to institute proceedings for the collection of begin delete compensation,
including vocational rehabilitation services, end delete begin insert compensation end insert within
five years after the date of the injury upon the ground that the
original injury has caused new and further begin delete disability or that the
provision of vocational rehabilitation services has become feasible
because the employee’s medical condition has improved or because
of other factors not capable of determination at the time the
employer’s liability for vocational rehabilitation services otherwise
terminated. end delete begin insert disability. end insert The jurisdiction of the appeals board in these
cases shall be a continuing jurisdiction within this period. This
section does not extend the limitation provided in Section 5407.