BILL NUMBER: AB 2407 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 27, 2016
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. Existing law requires the administrative
director to adopt a medical treatment utilization schedule, as
specified.
This bill would, if the employee's injury affects his or her back,
require a physician or other medical 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. pain utilizing the
medical treatment utilization schedule and determine treatment based
on that schedule.
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 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.
utilizing the medical treatment utilization schedule
(MTUS) adopted pursuant to Section 5307.27 and determine treatment
based on that schedule.
(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.