BILL ANALYSIS                                                                                                                                                                                                    






               Senate Committee on Labor and Industrial Relations
                             Richard Alarcon, Chair

          Date of Hearing: April 23, 2003      2003-2004 Regular  
          Session                              
          Consultant: Liberty Reiter Sanchez   Fiscal:No
                                               Urgency:No
          
                                Bill No: SB 414
                               Author: McClintock
                    Version: As Introduced February 20, 2003
          

          Subject:

          Workers' compensation:  injuries

          Purpose:
          
          To revise the definition of injury as it pertains to  
          workers' compensation to mean an injury or disease, which  
          is certified by a physician using medical evidence based on  
          objective medical findings.

          Analysis:
          
          Existing law defines injury, for the purposes of workers'  
          compensation, to mean any injury or disease arising out of  
          the employment.

          Presently, when an injured worker seeks the care of a  
          medical provider for treatment of an occupational injury,  
          the medical provider must make an initial determination  
          regarding whether an injury exists.  The medical provider  
          does not make a determination regarding whether the injury  
          was work related, that determination, if in dispute is made  
          by the Workers' Compensation Administrative Law Judges  
          employed by the Division of Workers Compensation.  Medical  
          providers must also make determinations regarding the  
          extent of the injury sustained by the employee.

          Existing law generally provides that a medical provider's  
          evaluation be supported, to the extent possible, by medical  
          findings based on standardized examinations and testing  
          techniques generally accepted by the medical community.   
          Additionally, the method of measuring a disability is  









          required to be in accordance with the report of the Joint  
          Committee of the California Medical Association and  
          Industrial Accident Commission.  

          Medical providers are not limited under existing law to  
          consideration of objective findings alone in medical  
          determinations for the purposes of workers' compensation.   
          It is current practice for medical providers to use  
          subjective as well as objective evidence in making medical  
          determinations for workers' compensation purposes.
           
          This Bill  , redefines "injury" as it pertains to workers'  
          compensation to require certification by a physician using  
          "medical evidence based on objective medical findings."

          Comments:

          (1)  Current Practice and Potential Impact:

            Currently, there are many injuries or illnesses, which if  
            required to be diagnosed by objective findings alone,  
            might remain undiagnosed, untreated and uncompensated.   
            Examples of these are strain injuries, brain concussions,  
            chemical exposures, psychiatric injuries and all such  
            injuries, which are determined mostly by patient pain.  A  
            large majority of back injuries, which comprise one third  
            of all workers' compensation injuries, initially present  
            themselves as pain to the patient, but would be  
            undetectable on an MRI.

            Amending the definition of injury in this manner would  
            not only impact initial diagnoses, and initial  
            compensability determinations, but also would also impact  
            the permanent disability rating system, which takes into  
            account subjective complaints. 

           (2)Commission on Health and Safety and Workers'  
             Compensation (CHSWC) /RAND    
             Study:

          Hearing Date:  April 23, 2003                            SB  
          414  
          Consultant: Liberty Reiter Sanchez                           
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            The RAND Corporation, under contract with CHSWC is  
            currently conducting an in-depth study of workers'  
            compensation permanent disability.  The CHSWC/RAND study  
            proposes to include a review of increased reliance on  
            objective medical findings in disability ratings,  
            including the extent to which such an approach can  
            improve consistency and appropriate benefit disbursement.  


          (3)   Proponents  :
            
            The California Chamber of Commerce, the sponsors of the  
            bill, contend that California businesses are being  
            "rocked by out-of-control workers' compensation insurance  
            premium increases" and that the workers' compensation  
            system must be reformed in order to "lower the costs of  
            providing benefits for injured workers."

            The California Association for Health Services at Home  
            asserts that back injuries to home care workers are  
            common, and that this bill will help ensure that  
            "monetary awards are based on injuries in the workplace."

          (4)   Opponents  :

            Contend that a bill of this nature will be more costly to  
            employers in the long run because injured workers will  
            wait to report their occupational injury until the pain  
            has manifested itself into something which can be  
            quantified by objective medical findings.  Resultantly,  
            permanent disability awards and medical costs would  
            increase.

            The California Society of Industrial Medicine and Surgery  
            argues that the diagnosis of an injury involves a  
            combination of objective and subjective findings by the  
            physician.  In fact, in many injuries there may be no  
            objective findings due to the current state of medicine.   
            They conclude that prohibiting the consideration of  
            subjective findings would have the effect of not  
          Hearing Date:  April 23, 2003                            SB  
          414  
          Consultant: Liberty Reiter Sanchez                           
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            recognizing many valid occupational injuries, and would  
            lead to employers increased vulnerability to legal  
            action.

            The California Applicants' Attorneys Association (CAAA)  
            asserts that this bill confuses "disability" with  
            "impairment," because disability refers to limitations on  
            the quality of life and the ability to compete in the  
            labor market and impairment refers to functional  
            limitations.  CAAA argues that it is for this reason that  
            the American Medical Association has held that objective  
            medical findings are not appropriate for determining  
            disability.

          (5)   Related Legislation  :

            SB 893 (Morrow), also before this committee today, would  
            require that objective medical findings be used when  
            considering the nature of the physical injury or  
            disfigurement for purposes of determining an injured  
            workers permanent disability rating.
            
            AB 1481 (Richman), currently in the Assembly Insurance  
            Committee, would require that all evaluations and reports  
            prepared by a physician with regard to the degree of  
            permanent whole body impairment that an employee has  
            sustained be based on demonstrable medical evidence that  
            indicates how the impairment restricts the function of  
            the body.


          Support: 
          
          California Chamber of Commerce (Sponsor)
          Agricultural Council of California -Support in Concept
          American Electronics Association
          ARV Assisted Living
          Association of California Water Agencies
          Automotive Aftermarket Services, Inc.
          Best Western South Coast Inn
          Hearing Date:  April 23, 2003                            SB  
          414  
          Consultant: Liberty Reiter Sanchez                           
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          Blue Banner Company, Inc.
          BMW of North America
          Brawley Chamber of Commerce
          CA Agricultural Aircraft Association -Support in Concept 
          CA Assoc. of Nurseries & Garden Centers -Support in Concept
          CA Beer and Beverage Distributors -Support in Concept
          CA Citrus Mutual -Support in Concept 
          Ca Cotton Ginners Association -Support in Concept
          CA Farm Bureau Federation -Support in Concept
          CA Fig Institute -Support in Concept 
          CA Grocers Association -Support in Concept
          CA Lodging Industry Association -Support in Concept
          CA Plant Health Association -Support in Concept
          CA Restaurant Association -Support in Concept
          CA State Association of Counties -Support in Concept
          Ca Women for Agriculture -Support in Concept
          California Apartment Association
          California Association for Health Services at Home
          California Association of Independent Business, Inc.
          California Association of Joint Powers Authorities
          California Cut Flower Commission
          California Landscape Contractors Association
          California Manufacturers and Technology Association
          California Retailers Association
          California Sheet Metal and Air Conditioning Contractors  
          National Association
          California Space Authority
          Camarillo Chamber of Commerce
          Camelot Furniture Corporation (Orange)
          Carpenteria Chamber of Commerce
          Cathy Martinez (Lompoc)
          CB Richard Ellis Brokerage Services of Ventura
          Chico Chamber of Commerce
          Chocolates a la Carte
          DAC International
          Dr. Charles Durand
          Eagle Road Service and Tire, Inc. (Riverside)
          Eastern Municipal Water District
          Engineering and Utility Contractors Association
          Family First out of Woodland Hills (with 17 individuals  
          Hearing Date:  April 23, 2003                            SB  
          414  
          Consultant: Liberty Reiter Sanchez                           
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          from that company also adding their name)
          Gandrud Financial Services Coorporation
          Gandrud Financial Services Corporation (Carpenteria)
          Golden State Builders Exchanges
          Goleta Chamber of Commerce
          Hobbs Trucking Company
          Industrial Mental Supply Co. (Sun Valley)
          Insurance Agents and Brokers Legislative Council
          Irvine Chamber of Commerce
          Irvine Chamber of Commerce
          Kristen Amyx, President/CEO, Goleta Valley Chamber of  
          Commerce
          League of California Cities -Support in Concept
          Liberty Mutual Group
          Maximum Nursery (Carpenteria)
          Milk Producers Council -Support in Concept
          Nat'l Federation of Independent Business -Support in  
          Concept
          Murrieta Chamber of Commerce
          Murrill Forrester, Board Member, Goleta Valley Chamber of  
          Commerce
          Natalie Peterson (Volt Services Group)
          National Federation of Independent Business
          Orange County Business Council
          Perfect Promotional Products (Oxnard)
          Piano City (Colton)
          R and W Enterprises
          Reetz, Fox and Barlett LLP
          Roofing Contractors Association of California
          Russell A. Goodman, Board Member, Goleta Valley Chamber of  
          Commerce
          Sacramento Metropolitan Chamber of Commerce
          SAI Spectrum Assembly, Inc.
          Santa Barbara County Farm Bureau
          Santa Barbara County Taxpayers Association
          Santa Barbara Human Resources Association
          Santa Barbara Industrial Association
          Sares-Regis Group (Oxnard)
          Schnadig Corporation
          Select Personnel Services
          Hearing Date:  April 23, 2003                            SB  
          414  
          Consultant: Liberty Reiter Sanchez                           
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          Senderex Cargo Inc. out of LA
          Small Business of America, Inc.
          Steven Fedde, Board Member, Goleta Valley Chamber of  
          Commerce
          Sun Valley Floral Farms
          Sunrise Growers 
          Sunrise Growers
          TBS Teamwork Business Services, Inc. of Santa Maria
          The Lafayette Company
          Tulare Chamber of Commerce
          United Agribusiness League
          Ventura Chamber of Commerce
          Volt Services Group
          Volt Services Group (Abbi Dodds, Sacramento Manufacturing  
          and Logistics Division)
          Volt Services Group (Angie Isais, Recruiting Coordinator)
          Volt Services Group (Carla Moorehead)
          Volt Services Group (Carmen Meeks)
          Volt Services Group (Chad Garrison, Sacramento  
          Manufacturing and Logistics Division)
          Volt Services Group (Costa Mesa)
          Volt Services Group (Dolores Torres, Sacramento  
          Manufacturing and Logistics Division)
          Volt Services Group (Donna Persson, Brea)
          Volt Services Group (Hope Miller)
          Volt Services Group (Jeff Barnett, Torrance)
          Volt Services Group (Jeff Langenwalter, Brea)
          Volt Services Group (Jessica Ortiz, Roseville)
          Volt Services Group (Judy Fox, Anaheim branch)
          Volt Services Group (Karen Brooks, Santa Barbara)
          Volt Services Group (Kathi Rutherford)
          Volt Services Group (Kathryn Rigney, Mission Viejo)
          Volt Services Group (Kirk A. Martin, Santa Barbara)
          Volt Services Group (Laura Lemmons, Santa Barbara)
          Volt Services Group (Linda Shriffman, Los Angeles Branch  
          Manager)
          Volt Services Group (Martin Boggs, Sacramento  
          Administrative and Accounting Div)
          Volt Services Group (Mayra Carranza, Sacramento  
          Manufacturing and Logistics Div)
          Hearing Date:  April 23, 2003                            SB  
          414  
          Consultant: Liberty Reiter Sanchez                           
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          Volt Services Group (Michele Pagliar, Santa Claritai)
          Volt Services Group (Rochelle Burge, Cerritos)
          Volt Services Group (Salena Sweet-Robinson, Torrance)
          Volt Services Group (Santa Barbara)
          Volt Services Group (Sharon Barton, Regional Manager Santa  
          Barbara)
          Volt Services Group (Sherrie Stanton, Anaheim)
          Volt Services Group (Sherry Craig, Torrance)
          Volt Services Group (Stormy Morris, Sacramento  
          Manufacturing and Logistics Division)
          Volt Services Group (Tania Lewis, Pasadena)
          Volt Services Group (Teri Mustol)
          Volt Services Group (Tracie Haidle, Sacramento  
          Manufacturing and Logistics Division)
          Volt Workforce Design (Chasin Scott, Menlo Park)
          Volt Workforces Design (Alexis Macias, Roseville)
          Volt Workforces Design (April Castro, Roseville)
          Volt Workforces Design (Carmen Meeks, Roseville)
          Volt Workforces Design (Marlee Leavitt, El Cajon)
          Volt Workforces Design (Nicole Feltsen, Roseville)
          Western Growers Association -Support in Concept
          William J. Clark, D.D.S., M.D.
          Wollborg/Michelson Personnel Services, Inc. (San Francisco)

          
          Opposition:
          
          California Applicants' Attorneys Association
          California Conference Board of the Amalgamated Transit  
          Union
          California Conference of Machinists
          California Independent Public Employees Legislative Council
          California Labor Federation, AFL-CIO
          California Psychiatric Association
          California Society of Industrial Medicine and Surgery
          California Teamsters Public Affairs Council
          Consumer Attorneys of California
          Engineers and Scientist of California, IFPTE Local 20,  
          AFL-CIO
          Hotel Employees & Restaurant Employees International Union
          Hearing Date:  April 23, 2003                            SB  
          414  
          Consultant: Liberty Reiter Sanchez                           
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          Jockeys' Guild
          Professional and Technical Engineers, IFPTE Local 21,  
          AFL-CIO
          United Food & Commercial Workers Region 8 States Council

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          Hearing Date:  April 23, 2003                            SB  
          414  
          Consultant: Liberty Reiter Sanchez                           
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          Senate Committee on Labor and Industrial Relations