BILL NUMBER: AB 2749 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 8, 2010
INTRODUCED BY Assembly Members Logue and Norby
FEBRUARY 19, 2010
An act to amend Section 4903 4903.5
of the Labor Code, relating to workers' compensation.
LEGISLATIVE COUNSEL'S DIGEST
AB 2749, as amended, Logue. Workers' compensation.
compensation: lien claims.
Existing workers' compensation law generally requires employers to
secure the payment of workers' compensation, including medical
treatment, for injuries incurred by their employees that arise out
of, and in the course of, employment. Existing law authorizes a
medical provider to file a lien claim with the Workers' Compensation
Appeals Board for certain expenses incurred by the provider.
Existing law prohibits lien claims for expenses incurred by or on
behalf of the injured employee, as provided, and, to the extent that
the employee is entitled to reimbursement, as specified, for
medical-legal expenses, from being filed after 6 months from the date
on which the appeals board or workers' compensation administrative
law judge issues a final decision, findings, order, or award on the
merits of the claim, after 5 years from the date of the injury for
which the services were provided, or after one year from the date the
services were provided, whichever is later.
This bill would, instead, prohibit lien claims for the
above-described expenses from being filed one year from the date the
services were provided. The bill would prohibit lien claims for
expenses incurred for providing inpatient medical services from being
filed after 6 months from the date the provider of those services
knew or should have known the inpatient services were for treating an
industrial injury.
This bill would require employers or employers' insurance carriers
to include a benefit notice with any objection to a bill for medical
services or an explanation of benefits that advises the provider of
those services or benefits of the above-described deadline for filing
lien claims and the consequences of failing to meet that deadline.
This bill would require the above-described lien claims to be
accompanied by certain documentation, including the original bill or
bills for the services. The bill would provide that if the lien claim
does not include the documentation, it shall be rejected, shall not
receive further consideration, and that notice shall be provided to
all parties of record that the lien claimant did not meet the
documentation requirements and that the lien claim has been rejected.
Existing law establishes a workers' compensation system,
administered by the Administrative Director of the Division of
Workers' Compensation, which requires employers to secure the payment
of workers' compensation, including medical treatment, for injuries
incurred by their employees that arise out of, and in the course of,
employment. Existing law provides for the creation of the Workers'
Compensation Appeals Board to hear appeals of workers' compensation
disputes, as specified. Existing workers' compensation law authorizes
the appeals board to determine and allow specified expenses,
including reasonable attorney's fees for legal services, as liens
against any sum to be paid as compensation.
This bill would make technical, nonsubstantive changes to the
above-described provisions.
Vote: majority. Appropriation: no. Fiscal committee: no
yes . State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 4903.5 of the Labor
Code is amended to read:
4903.5. (a) No (1)
Except as provided in paragraph (2), no lien claim for expenses
as provided in subdivision (b) of Section 4903 may be filed after
six months from the date on which the appeals board or a
workers' compensation administrative law judge issues a final
decision, findings, order, including an order approving compromise
and release, or award, on the merits of the claim, after five years
from the date of the injury for which the services were provided, or
after one year from the date the services were
provided, whichever is later provided .
(2) No lien claim for expenses incurred for providing inpatient
medical services may be filed after six months from the date the
provider of those services knew or should have known the inpatient
services were for treating an industrial injury.
(b) Notwithstanding subdivision (a), any health care provider,
health care service plan, group disability insurer, employee benefit
plan, or other entity providing medical benefits on a nonindustrial
basis, may file a lien claim for expenses as provided in subdivision
(b) of Section 4903 within six months after the person or entity
first has knowledge that an industrial injury is being claimed.
(c) The injured worker shall not be liable for any underlying
obligation if a lien claim has not been filed and served within the
allowable period. Except when the lien claimant is the applicant as
provided in Section 5501, a lien claimant shall not file a
declaration of readiness to proceed in any case until the
case-in-chief has been resolved.
(d) This section shall not apply to civil actions brought under
the Cartwright Act (Chapter 2 (commencing with Section 16700) of Part
2 of Division 7 of the Business and Professions Code), the Unfair
Practices Act (Chapter 4 (commencing with Section 17000) of Part 2 of
Division 7 of the Business and Professions Code), or the federal
Racketeer Influenced and Corrupt Organization Act (Chapter 96
(commencing with Section 1961) of Title 18 of the United States Code)
based on concerted action with other insurers that are not parties
to the case in which the lien or claim is filed.
(e) Employers or employers' insurance carriers shall include a
benefit notice with any objection to a bill for medical services or
an explanation of benefits that advises the provider of those
services or benefits of the deadline for filing lien claims described
in subdivision (a) and the consequences of failing to meet that
deadline.
(f) (1) A lien claimant filing a claim for expenses as provided in
subdivisonsubdivision (b) of Section 4903 shall include the
following documentation with the lien claim:
(A) The original bill or bills for the services for which the lien
claim is being filed. Ledger or billing payment histories shall not
be sufficient for purposes of complying with this subparagraph.
(B) A statement stating that the expenses for which the lien claim
is being made were incurred for services authorized by the employer
or, if the expenses were not authorized by the employer, that the
expenses were for services justified for another specified reason.
(C) Certification that the lien claim complies with applicable
statutes and rules.
(2) If a lien claim for expenses as provided in subdivision (b) of
Section 4903 does not include the documentation required by
paragraph (1), all of the following shall occur:
(A) The lien claim shall be rejected.
(B) The lien claim shall receive no further consideration.
(C) Notice shall be provided to all parties of record that the
lien claimant did not meet the requirements under this subdivision
and that the lien claim has been rejected.
SECTION 1. Section 4903 of the Labor Code is
amended to read:
4903. The appeals board may determine, and allow as liens against
any sum to be paid as compensation, any amount determined as
hereinafter set forth in subdivisions (a) to (i), inclusive. If more
than one lien is allowed, the appeals board may determine the
priorities, if any, between the liens allowed. The liens that may be
allowed hereunder are as follows:
(a) A reasonable attorney's fee for legal services pertaining to
any claim for compensation either before the appeals board or before
any of the appellate courts, and the reasonable disbursements in
connection therewith. No fee for legal services shall be awarded to
any representative who is not an attorney, except with respect to
those claims for compensation for which an application, pursuant to
Section 5501, has been filed with the appeals board on or before
December 31, 1991, or for which a disclosure form, pursuant to
Section 4906, has been sent to the employer, or insurer or
third-party administrator, if either is known, on or before December
31, 1991.
(b) The reasonable expense incurred by or on behalf of the injured
employee, as provided by Article 2 (commencing with Section 4600)
and, to the extent the employee is entitled to reimbursement pursuant
to Section 4621, medical-legal expenses as provided by Article 2.5
(commencing with Section 4620) of Chapter 2 of Part 2.
(c) The reasonable value of the living expenses of an injured
employee or of his or her dependents, subsequent to the injury.
(d) The reasonable burial expenses of the deceased employee, not
to exceed the amount provided for by Section 4701.
(e) The reasonable living expenses of the spouse or minor children
of the injured employee, or both, subsequent to the date of the
injury, where the employee has deserted or is neglecting his or her
family. These expenses shall be allowed in the proportion that the
appeals board deems proper, under application of the spouse, guardian
of the minor children, or the assignee, pursuant to subdivision (a)
of Section 11477 of the Welfare and Institutions Code, of the spouse,
a former spouse, or minor children. A collection received as a
result of a lien against a workers' compensation award imposed
pursuant to this subdivision for payment of child support ordered by
a court shall be credited as provided in Section 695.221 of the Code
of Civil Procedure.
(f) The amount of unemployment compensation disability benefits
that have been paid under or pursuant to the Unemployment Insurance
Code in those cases where, pending a determination under this
division there was uncertainty whether the benefits were payable
under the Unemployment Insurance Code or payable hereunder; provided,
however, that any lien under this subdivision shall be allowed and
paid as provided in Section 4904.
(g) The amount of unemployment compensation benefits and extended
duration benefits paid to the injured employee for the same day or
days for which he or she receives, or is entitled to receive,
temporary total disability indemnity payments under this division;
provided, however, that any lien under this subdivision shall be
allowed and paid as provided in Section 4904.
(h) The amount of family temporary disability insurance benefits
that have been paid to the injured employee pursuant to the
Unemployment Insurance Code for the same day or days for which that
employee receives, or is entitled to receive, temporary total
disability indemnity payments under this division, provided, however,
that any lien under this subdivision shall be allowed and paid as
provided in Section 4904.
(i) The amount of indemnification granted by the California
Victims of Crime Program pursuant to Article 1 (commencing with
Section 13959) of Chapter 5 of Part 4 of Division 3 of Title 2 of the
Government Code.
(j) The amount of compensation, including expenses of medical
treatment, and recoverable costs that have been paid by the Asbestos
Workers' Account pursuant to the provisions of Chapter 11 (commencing
with Section 4401) of Part 1.