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 --