BILL ANALYSIS
Senate Committee on Labor and Industrial Relations
Mark DeSaulnier, Chair
Date of Hearing: March 25, 2009 2009-2010 Regular
Session
Consultant: Alma Perez Fiscal:No
Urgency: No
Bill No: SB 186
Author: DeSaulnier
Version: As introduced February 17, 2009
SUBJECT
Workers' compensation: medical treatment: predesignation of
physician.
KEY ISSUE
Should employees be allowed to retain the right to predesignate
a personal physician to treat them in the event of a
work-related injury?
PURPOSE
To delete the December 31, 2009 sunset date that will, after
that date, eliminate the right of workers to predesignate a
personal physician for the purposes of workers compensation.
ANALYSIS
Existing law requires employers to secure the payment of
workers' compensation for injuries incurred by their employees
that arise out of, or in the course of, employment. Workers'
compensation insurance provides six basic benefits which include
medical care, temporary disability benefits, permanent
disability benefits, supplemental job displacement benefits or
vocational rehabilitation and death benefits. In most cases
when there is a work-related injury, the injured worker is
referred to, and placed under the care of, a physician chosen by
the employer for the first 30 days. After that period the
injured worker is allowed to go to his/her own doctor for
treatment, except in the circumstance where an employer has
established a "medical provider network," in which case the
employee must continue his/her medical treatment with a
physician within the network. (Labor Code 4616)
Under specified circumstances , however, a worker has the right,
prior to injury, to name a personal physician to be responsible
for his/her medical treatment in the event that he/she later
suffers an on-the-job injury. And if eligible, the worker may
see his/her personal physician from the date of injury. The
right of an employee to notify his/her employer of their desired
physician for treatment in case of a work-related injury is
known as "predesignation."
Under existing law , employees make a valid physician
predesignation if:
The worker's employer offers non-occupational group
health coverage;
The doctor is the worker's regular physician, as
specified, and has previously directed his/her medical
treatment and retains his/her medical records;
The worker's "personal physician" may be a medical
group if it is a single corporation or partnership composed
of licensed doctors of medicine or osteopathy, which
operates an integrated multi specialty medical group
providing comprehensive medical service predominantly for
nonoccupational illnesses and injuries;
Prior to the injury the worker's doctor agrees to be
predesignated and treat the worker in case of work injuries
or illnesses;
Prior to the injury the worker provides his/her employer
the following in writing:
o Notice that he/she wants their personal doctor
to treat him/her for a work-related injury or illness
and,
o The worker's personal doctor's name and
business address.
Existing law requires employers to notify employees of the right
to predesignate a personal physician and provide the new
employees with physician predesignation forms upon hire or by
Hearing Date: March 25, 2009 SB 186
Consultant: Alma Perez Page 2
Senate Committee on Labor and Industrial Relations
the end of the first pay period. The provisions in law allowing
employees to predesignate their personal physician will be
repealed on December 31, 2009, unless a later enacted statute
deletes or extends this date.
This Bill would delete the December 31, 2009 repeal date on the
right of employee's to predesignate their personal physician,
therefore retaining in law an employee's right to predesignate.
In addition, this bill would delete a requirement that the
Division of Workers' Compensation conduct an evaluation of
certain predesignation provisions and present its finding to the
Governor and the Legislature by December 31, 2008.
COMMENTS
1. Need for this bill?
There are legitimate reasons to allow an employee to be
treated by his/her own doctor. A physician who has been
seeing an individual for non-occupational illnesses will
likely have a familiarity with the medical history of the
patient and is therefore more able to deliver appropriate
treatment, which could result in more efficient medical care.
Additionally, a recent study by the Workers' Compensation
Research Institute (WCRI) and the Public Policy Institute of
California (PPIC) found that there are higher levels of worker
satisfaction with the workers' compensation system when the
injured workers are treated by their personal doctor. The
study also found that there was little evidence of higher
costs associated with predesignation in those cases. [The
Impact of Provider Choice on Workers' Compensation Costs and
Outcomes; WCRI, PPIC; Victor, Barth, Neumark; November 2005]
Unless the sunset date on the right of a worker to
predesignate is deleted, as of December 31, 2009, workers
would no longer be able to see a doctor of their choice from
the date he/she suffers a work-related injury. If workers
lose the right to predesignate their physician, presumably
employers and/or insurance carriers would thenceforth direct
any and all injured workers to physicians specified by the
Hearing Date: March 25, 2009 SB 186
Consultant: Alma Perez Page 3
Senate Committee on Labor and Industrial Relations
employer/carrier for the initial 30-day period before the
worker is allowed to go to a doctor of his/her own choice. In
addition, in cases where an employer or carrier has
established a medical provider network (MPN), the injured
worker would lose the right to have both initial and on-going
treatment by a doctor of his/her own choice outside the MPN.
This bill would preserve a workers right to designate their
treating physician in the event of a work related injury past
the December 31, 2009 sunset date.
Additionally, this bill also deletes a report requirement
which was due by a date that is now obsolete. Labor Code
4600, required the Division of Workers' Compensation (DWC) to
conduct an evaluation of the predesignation program and
present its findings to the Governor and the Legislature on or
before December 31, 2008. The DWC does not believe it has the
information needed to produce such a report, nor does it have
the funds to do it.
2. Proponent Arguments :
According to supporters of the bill, the predesignation of a
treating physician is an important protection against the
forced use of an employer-chosen doctor following a work place
injury. Supporters of the bill say that employees who are
allowed to see their own doctors after sustaining a workplace
injury typically return to work earlier because their
satisfaction level is high. They argue that as a result,
employer costs are significantly reduced since employers do
not frequently have to train replacement workers or to have
other workers take on more overtime.
Proponents of the bill also note that amendments made to labor
code in 2006 clarified that a treating physician was to follow
HMO and PPO guidelines in making referrals to other physician,
thus a treating physician must follow group health guidelines
for treatments and referrals when treating patients under a
workers' compensation claim. Additionally, supporters of the
bill reference the findings in the WCRI/PPIC study which
demonstrated that the limited right of some employees to
predesignate their physician showed that employer costs are no
higher when workers choose a doctor they have a prior
Hearing Date: March 25, 2009 SB 186
Consultant: Alma Perez Page 4
Senate Committee on Labor and Industrial Relations
relationship with, yet employee satisfaction with the workers'
compensation system was much higher.
3. Opponent Arguments :
Opponents of the bill agree that an injured worker may be more
comfortable using their family doctor and may well receive
better treatment from a doctor who has a history of treating
them over time. They argue, however, that this benefit does
not transfer to other physicians who may have to treat the
injured worker for their work-related injury or illness
following a referral from their primary treating physician.
Opponents argue that while these other physicians do indeed
treat the injured worker, they do not direct the treatment
plan. Opponents believe that any treatments outside that
which is provided by the primary treating physician should be
received inside the Medical Provider Network (MPN) that would
be otherwise applicable.
Opponents also argue that even if the provisions that allow
predesignation were to expire, predesignation could still be
possible under the law that gives union employers and their
employees the ability to negotiate the provision of a workers'
compensation system through a carve-out. Lastly, some
opponents believe that the report requirement that this bill
seeks to eliminate should be completed and examined prior to
any decision to extend the sunset on predesignation.
4. Prior Legislation :
SB 1338 (Migden) of 2008: Vetoed by the Governor
This bill sought to retain in law the right to predesignation
by deleting the December 31, 2009 sunset. In his veto message
the Governor stated that, "My workers' compensation reforms
struck the appropriate balance between the employer and the
employee in selecting the physicians that treat injured
workers. There is no reason a select few employees should be
allowed to opt out of a system that is working well for
everyone else."
AB 2068 (Nava) of 2006: Chaptered
This bill extended the sunset date on the right of an employee
Hearing Date: March 25, 2009 SB 186
Consultant: Alma Perez Page 5
Senate Committee on Labor and Industrial Relations
to predesignate their personal physician from April 30, 2007
to December 31, 2009.
SUPPORT
California Labor Federation, AFL-CIO (Sponsor)
California Professional Firefighters (Sponsor)
California Teamsters Public Affairs Council (Co-sponsors)
Amalgamated Transit Union
American Federation of State, County and Municipal Employees
(AFSCME), AFL-CIO
California Conference of Machinists
California Nurses Association (CNA)
California School Employees Association, AFL-CIO (CSEA)
Engineers and Scientists of California
Glendale City Employees Association (GCEA)
IFPTE Local 21
International Longshore and Warehouse Union
National Nurses Organizing Committee (NNOC)
Organization of SMUD Employees (OSE)
Peace Officer's Research Association of California (PORAC)
San Bernardino Public Employees Association (SBPEA)
San Diego County Court Employees Association
San Luis Obispo County Employees Association (SLOCEA)
Santa Rosa City Employees Association (SRCEA)
Strategic Committee of Public Employees, Laborers' International
Union of North America
UNITE HERE!
United Food and Commercial Workers Union, Western States Council
United Transportation Union
OPPOSITION
Acclamation Insurance Management Services (AIMS)
Alpha Fund
American Fence Contractors' Association, California Chapter
California Association of Joint Powers Authorities (CAJPA)
California Chamber of Commerce
California Coalition on Workers' Compensation (CCWC)
Hearing Date: March 25, 2009 SB 186
Consultant: Alma Perez Page 6
Senate Committee on Labor and Industrial Relations
California Fence Contractors' Association
California Special Districts Association (CSDA)
California State Association of Counties (CSAC)
CSAC-Excess Insurance Authority (CSAC-EIA)
Engineering Contractors' Association
Flasher/Barricade Association
League of California Cities (LCC)
Marin Builders' Exchange
Regional Council of Rural Counties (RCRC)
* * *
Hearing Date: March 25, 2009 SB 186
Consultant: Alma Perez Page 7
Senate Committee on Labor and Industrial Relations