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
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|Author: |Mendoza |
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|Version: |April 6, 2015 |
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|Urgency: |No |Fiscal: |No |
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|Consultant:|Gideon Baum |
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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
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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
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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.
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