BILL ANALYSIS Ó SENATE COMMITTEE ON LABOR AND INDUSTRIAL RELATIONS Senator Tony Mendoza, Chair 2015 - 2016 Regular Bill No: SB 522 Hearing Date: April 22, 2015 ----------------------------------------------------------------- |Author: |Mendoza | |-----------+-----------------------------------------------------| |Version: |April 6, 2015 | ----------------------------------------------------------------- ----------------------------------------------------------------- |Urgency: |No |Fiscal: |No | ----------------------------------------------------------------- ----------------------------------------------------------------- |Consultant:|Gideon Baum | | | | ----------------------------------------------------------------- Subject: Workers' compensation: advertisements KEY ISSUE Should the Legislature differentiate between two processes in California's workers' compensation system that are both known as "Independent Medical Review"? ANALYSIS Existing law establishes a workers' compensation system that provides benefits to an employee who suffers from an injury or illness that arises out of and in the course of employment, irrespective of fault. This system requires all employers to secure payment of benefits by either securing the consent of the Department of Industrial Relations to self-insure or by securing insurance against liability from an insurance company duly authorized by the state. Existing law provides that 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 SB 522 (Mendoza) Page 2 of ? injured worker from the effects of his or her injury shall be provided by the employer. (Labor Code §4600) Existing law allows an insurer, employer, or entity that provides physician network services to establish a medical provider network (MPN) for the provision of medical treatment to injured employees. The network shall include physicians primarily engaged in the treatment of occupational injuries to treat common injuries experienced by injured employees based on the type of occupation or industry in which the employee is engaged, and the geographic area where the employees are employed. (Labor Code §4616) Existing law provides that, in the event over a dispute over a utilization review decision, all disputes must be submitted for Independent Medical Review (IMR). The independent reviewer's information must be kept confidential. (Labor Code §§4610.5 and 4610.6) Existing law also creates a process through which an injured worker in a MPN may seek an independent medical opinion if the injured worker does not agree with the MPN physician's diagnosis or recommended medical treatment. This process is ALSO known as independent medical review. (Labor Code §4616.4) This bill would rename the process through which an injured worker in a MPN may seek an independent medical opinion as "MPN independent medical review". COMMENTS 1. Need for this bill? As was noted above, there are currently two very different processes in workers' compensation that are known as "Independent Medical Review". In the Medical Provider Network (MPN), the independent medical review process grants injured workers the ability to seek an independent third-party opinion if he or she disagrees with the medical treatment or diagnosis from his or her MPN physician. As this dispute is between a physician and the injured worker, this is very different from the more commonly-known IMR process, which is a disputed Utilization Review (UR) decision and is essentially between SB 522 (Mendoza) Page 3 of ? the physician and the payor, not the injured worker. SB 522 will clarify the difference between the two IMR processes. 2. Proponent Arguments : The author notes that, under existing law, the workers' compensation system has two processes that are known as independent medical review. The author believes that this could create confusion and create barriers for injured workers to access their rights. The author argues that SB 522 resolves this issue by retitling the independent opinion process within a MPN as "MPN independent medical review", thereby clarifying the different processes and helping to ensure injured workers better understand the rights that are available to them. 3. Opponent Arguments : None on file. 4. Prior Legislation : SB 899 (Poochigian), Statutes of 2004, Chapter 34, created, among other things, Medical Provider Networks (MPNs). SUPPORT None received. OPPOSITION None received. -- END --