BILL ANALYSIS Ó
AB 2086
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB
2086 (Cooley and Mathis)
As Amended August 1, 2016
2/3 vote. Urgency
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|ASSEMBLY: |76-0 |(April 28, |SENATE: |39-0 |(August 22, |
| | |2016) | | |2016) |
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Original Committee Reference: INS.
SUMMARY: Provides a statutory authorization for
neuropsychologists to perform the services of a qualified
medical examiner (QME) in the workers' compensation system.
The Senate amendments:
1)Delete the listing of the organizations that issue "board
certifications" to neuropsychologists, thereby qualifying the
practitioner to become a QME, and instead delegate to the
Administrative Director (AD) of the Division of Workers'
Compensation the responsibility to determine which certifying
organizations are acceptable for this purpose.
2)Make technical and conforming amendments.
AB 2086
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EXISTING LAW:
1)Establishes a comprehensive system to provide workers'
compensation benefits to employees who suffer injuries or
conditions that arise out of or in the course of employment.
Benefits include medical care to cure and relieve the effects
of the injury or condition, temporary disability benefits for
injured employees who are unable to work during the period of
recovery, permanent disability benefits for injured employees
who suffer permanent disabilities as a consequence of the
injury or condition, among other benefits.
2)Provides for a formal system of administrative dispute
resolution for cases where the employer and employee are not
in agreement over any issue associated with the delivery of
workers' compensation benefits.
3)Provides for the appointment of a QME to evaluate the injured
employee whenever disputed medical-legal issues arise.
4)Specifies the qualifications necessary for workers'
compensation physicians to be appointed as QMEs, including
with respect to physicians and surgeons, that they
successfully completed a residency program accredited by the
Accreditation Council for Graduate Medical Education (ACGME) -
the body recognized as the accrediting organization for
medical specialty training programs.
5)Authorized, until the adoption by the Division of Worker's
Compensation (DWC) of a regulation in 2015, neuropsychologists
to perform the function of a QME is appropriate brain trauma
cases.
6)Provides for AMEs, who perform essentially the same functions
as QMEs, but who are not selected randomly from DWC-generated
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lists and instead are selected by mutual agreement of the
parties.
FISCAL EFFECT: According to the Senate Appropriations
Committee, DIR would incur minor and absorbable costs to develop
new regulations. However, DIR anticipates that the bill would
result in unknown, potentially significant costs to the workers'
compensation system as a consequence of an increase in requests
for qualified medical examiner panels.
COMMENTS:
1)Purpose. According to the author, this bill is necessary
because neuropsychologists provide valuable input in serious
brain injury cases in the workers' compensation system.
Neuropsychologists appointed as QMEs have been providing this
input in workers' compensation cases for 22 years until the
DWC's regulation was adopted in 2015. The bill is intended to
override the regulation, and reinstate the opportunity for
neuropsychologists to perform QME functions.
2)QME process. When a medical-legal dispute arises, a QME is
appointed to evaluate the injured employee. "Medical-legal"
does not refer to whether or not a treatment at issue is
legally required. There is a separate medical treatment
dispute resolution process. "Medical- legal" relates to the
legal consequences of medical conditions, frequently the
extent to which an injured employee's injuries or conditions
are disabling, or whether the injuries or conditions have
become permanent and stationary. When there is a dispute on
an issue of this nature, a party can request appointment of a
QME. The requesting party specifies what sort of expertise is
needed to resolve the dispute, and the DWC appoints a panel,
from which a single QME is selected. If a neuropsychologist
is the expertise required, but only general psychologists are
on the QME lists, there is no guarantee that a person with the
proper expertise will be the QME. In that case, the
under-qualified QME will be forced, with additional expense
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and delay, to "consult" with a neuropsychologist. No
stakeholder group involved in workers' compensation has
suggested that this would be a desirable result.
3)ACGME. Currently, ACGME is the accepted entity that accredits
medical specialty training programs, and as a consequence the
Labor Code refers to completion of ACGME-accredited programs
as a basis to qualify to perform QME functions. However,
there are practicing physicians and surgeons who completed
their residency prior to the establishment of ACGME in the
early 1980's, and who could otherwise qualify as QMEs. The
bill also seeks to authorize the AD to accept as QMEs those
physicians who obtained their specialty training from a
predecessor accrediting organization.
4)Prior legislation. Last year, AB 1542 (Mathis and Cooley) was
substantially similar to this bill, and was unanimously
approved by the Legislature. However, the Governor vetoed AB
1542.
Analysis Prepared by:
Mark Rakich / INS. / (916) 319-2086 FN: 0004250