California Legislature—2015–16 Regular Session

Assembly BillNo. 2407


Introduced by Assembly Member Chávez

February 19, 2016


An act to amend Section 4600 of the Labor Code, relating to workers’ compensation.

LEGISLATIVE COUNSEL’S DIGEST

AB 2407, as introduced, Chávez. Workers’ compensation.

Existing law establishes a workers’ compensation system, administered by the Administrative Director of the Division of Workers’ Compensation, that generally requires employers to secure the payment of workers’ compensation for injuries incurred by their employees that arise out of, or in the course of, employment. Existing law requires an employer to provide all medical services reasonably required to cure or relieve the injured worker from the effects of the injury.

This bill would, if the employee’s injury affects his or her back, require a provider to assess the employee’s level of risk for chronic back pain and whether he or she meets the criteria for a surgical consultation. The bill would set forth the treatments that may be deemed appropriate after the assessment, as specified.

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

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

P1    1

SECTION 1.  

Section 4600 of the Labor Code is amended to
2read:

P2    1

4600.  

(a) Medical, surgical, chiropractic, acupuncture, and
2hospital treatment, including nursing, medicines, medical and
3surgical supplies, crutches, and apparatuses, including orthotic and
4prosthetic devices and services, that is reasonably required to cure
5or relieve the injured worker from the effects of his or her injury
6shall be provided by the employer.begin delete In the case of his or her neglect
7or refusal reasonably to do so,end delete
begin insert If the employer neglects or
8reasonably refuses to provide that treatment,end insert
the employer is liable
9for the reasonable expense incurred by or on behalf of the employee
10in providing treatment.

11(b) As used in this division and notwithstanding any other law,
12medical treatment that is reasonably required to cure or relieve the
13injured worker from the effects of his or her injury means treatment
14that is based upon the guidelines adopted by the administrative
15director pursuant to Section 5307.27.

16(c) Unless the employer or the employer’s insurer has
17established or contracted with a medical provider network as
18provided for in Section 4616, after 30 days from the date the injury
19is reported, the employee may be treated by a physician of his or
20her own choice or at a facility of his or her own choice within a
21reasonable geographic area. A chiropractor shall not be a treating
22physician after the employee has received the maximum number
23of chiropractic visits allowed by subdivision (c) of Section 4604.5.

24(d) (1) If an employee has notified his or her employer in
25writing prior to the date of injury that he or she has a personal
26physician, the employee shall have the right to be treated by that
27physician from the date of injury if the employee has health care
28coverage for nonoccupational injuries or illnesses on the date of
29injury in a plan, policy, or fund as described in subdivisions (b),
30(c), and (d) of Section 4616.7.

31(2) For purposes of paragraph (1), a personal physician shall
32meet all of the following conditions:

33(A) Be the employee’s regular physician and surgeon, licensed
34pursuant to Chapter 5 (commencing with Section 2000) of Division
352 of the Business and Professions Code.

36(B) Be the employee’s primary care physician and has
37previously directed the medical treatment of the employee, and
38who retains the employee’s medical records, including his or her
39medical history. “Personal physician” includes a medical group,
40if the medical group is a single corporation or partnership
P3    1composed of licensed doctors of medicine or osteopathy, which
2operates an integrated multispecialty medical group providing
3comprehensive medical services predominantly for
4nonoccupational illnesses and injuries.

5(C) The physician agrees to be predesignated.

6(3) If the employee has health care coverage for nonoccupational
7injuries or illnesses on the date of injury in a health care service
8plan licensed pursuant to Chapter 2.2 (commencing with Section
91340) of Division 2 of the Health and Safety Code, and the
10employer is notified pursuant to paragraph (1), all medical
11treatment, utilization review of medical treatment, access to
12medical treatment, and other medical treatment issues shall be
13governed by Chapter 2.2 (commencing with Section 1340) of
14Division 2 of the Health and Safety Code. Disputes regarding the
15provision of medical treatment shall be resolved pursuant to Article
165.55 (commencing with Section 1374.30) of Chapter 2.2 of
17Division 2 of the Health and Safety Code.

18(4) If the employee has health care coverage for nonoccupational
19injuries or illnesses on the date of injury in a group health insurance
20policy as described in Section 4616.7, all medical treatment,
21utilization review of medical treatment, access to medical
22treatment, and other medical treatment issues shall be governed
23by the applicable provisions of the Insurance Code.

24(5) The insurer may require prior authorization of any
25nonemergency treatment or diagnostic service and may conduct
26reasonably necessary utilization review pursuant to Section 4610.

27(6) An employee shall be entitled to all medically appropriate
28referrals by the personal physician to other physicians or medical
29providers within the nonoccupational health care plan. An
30employee shall be entitled to treatment by physicians or other
31medical providers outside of the nonoccupational health care plan
32pursuant to standards established in Article 5 (commencing with
33Section 1367) of Chapter 2.2 of Division 2 of the Health and Safety
34Code.

begin insert

35(7) If the employee’s injury affects his or her back, the physician
36or other medical provider shall assess the employee’s level of risk
37for chronic back pain and determine whether he or she meets the
38criteria for a surgical consultation. After the assessment, one or
39more of the following covered treatments may be deemed
40appropriate: acupuncture, chiropractic manipulation, cognitive
P4    1behavioral therapy, medications, including short-term opiate drugs,
2but excluding long-term prescriptions, office visits, osteopathic
3manipulation, and physical and occupational therapy. Surgery
4may be recommended, but only for a limited number of conditions
5and only if there is sufficient evidence to indicate that surgery is
6more effective than other treatment options. Yoga, intensive
7rehabilitation, massage, or supervised exercise therapy may also
8be recommended for inclusion in the comprehensive treatment
9plan.

end insert

10(e) (1) When at the request of the employer, the employer’s
11insurer, the administrative director, the appeals board, or a workers’
12compensation administrative law judge, the employee submits to
13examination by a physician, he or she shall be entitled to receive,
14in addition to all other benefits herein provided, all reasonable
15expenses of transportation, meals, and lodging incident to reporting
16for the examination, together with one day of temporary disability
17indemnity for each day of wages lost in submitting to the
18examination.

19(2) Regardless of the date of injury, “reasonable expenses of
20transportation” includes mileage fees from the employee’s home
21to the place of the examination and back at the rate of twenty-one
22cents ($0.21) a mile or the mileage rate adopted by the Director
23ofbegin insert the Department ofend insert Human Resources pursuant to Section 19820
24of the Government Code, whichever is higher, plus any bridge
25tolls. The mileage and tolls shall be paid to the employee at the
26time he or she is given notification of the time and place of the
27examination.

28(f) When at the request of the employer, the employer’s insurer,
29the administrative director, the appeals board, or a workers’
30 compensation administrative law judge, an employee submits to
31examination by a physician and the employee does not proficiently
32speak or understand the English language, he or she shall be
33entitled to the services of a qualified interpreter in accordance with
34conditions and a fee schedule prescribed by the administrative
35director. These services shall be provided by the employer. For
36purposes of this section, “qualified interpreter” means a language
37interpreter certified, or deemed certified, pursuant to Article 8
38(commencing with Section 11435.05) of Chapter 4.5 of Part 1 of
39Division 3 of Title 2 of, or Section 68566 of, the Government
40Code.

P5    1(g) If the injured employee cannot effectively communicate
2with his or her treating physician because he or she cannot
3proficiently speak or understand the English language, the injured
4employee is entitled to the services of a qualified interpreter during
5medical treatment appointments. To be a qualified interpreter for
6purposes of medical treatment appointments, an interpreter is not
7required to meet the requirements of subdivision (f), but shall meet
8any requirements established by rule by the administrative director
9that are substantially similar to the requirements set forth in Section
101367.04 of the Health and Safety Code. The administrative director
11shall adopt a fee schedule for qualified interpreter fees in
12accordance with this section. Upon request of the injured employee,
13the employer or insurance carrier shall pay for interpreter services.
14An employer shall not be required to pay for the services of an
15interpreter who is not certified or is provisionally certified by the
16person conducting the medical treatment or examination unless
17either the employer consents in advance to the selection of the
18individual who provides the interpreting service or the injured
19worker requires interpreting service in a language other than the
20languages designated pursuant to Section 11435.40 of the
21Government Code.

22(h) Home health care services shall be provided as medical
23treatment only ifbegin insert those services areend insert reasonably required to cure or
24relieve the injured employee from the effects of his or her injury
25and prescribed by a physician and surgeon licensed pursuant to
26Chapter 5 (commencing with Section 2000) of Division 2 of the
27Business and Professions Code, and subject to Section 5307.1 or
28begin delete 5703.8.end deletebegin insert 5307.8.end insert The employer shall not be liable for home health
29care services that are provided more than 14 days prior to the date
30of the employer’s receipt of the physician’s prescription.



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