Amended in Assembly April 27, 2016

California Legislature—2015–16 Regular Session

Assembly Bill No. 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 amended, 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. begin insert Existing law requires the administrative director to adopt a medical treatment utilization schedule, as specified. end insert

This bill would, if the employee’s injury affects his or her back, require a begin insert physician or other medical end insert provider to assess the employee’s level of risk for chronic back begin delete 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. end delete begin insert pain utilizing the medical treatment utilization schedule and determine treatment based on that schedule. 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 4600 of the Labor Code is amended to
read:

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. If the employer neglects or
reasonably refuses to provide that treatment, 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 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 (c) 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.

(7) If the employee’s injury affects his or her back, the physician
or other medical provider shall assess the employee’s level of risk
for chronic back pain begin delete and determine whether he or she meets the
criteria for a surgical consultation. After the assessment, one or
more of the following covered treatments may be deemed
appropriate: acupuncture, chiropractic manipulation, cognitive
behavioral therapy, medications, including short-term opiate drugs,
but excluding long-term prescriptions, office visits, osteopathic
manipulation, and physical and occupational therapy. Surgery may
be recommended, but only for a limited number of conditions and
only if there is sufficient evidence to indicate that surgery is more
effective than other treatment options. Yoga, intensive
rehabilitation, massage, or supervised exercise therapy may also
be recommended for inclusion in the comprehensive treatment
plan. end delete begin insert utilizing the medical treatment utilization schedule (MTUS)
adopted pursuant to Section 5307.27 and determine treatment
based on that schedule. end insert

(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 the Department 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 those services are 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
5307.8. 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.