BILL ANALYSIS
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|SENATE RULES COMMITTEE | SB 186|
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THIRD READING
Bill No: SB 186
Author: DeSaulnier (D)
Amended: As introduced
Vote: 21
SENATE LABOR & INDUST. RELATIONS COMMITTEE : 5-0, 3/25/09
AYES: DeSaulnier, Wyland, Ducheny, Leno, Yee
NO VOTE RECORDED: Cogdill
SUBJECT : Workers compensation: medical treatment:
predesignation
of physician
SOURCE : California Labor Federation, AFL-CIO
California Professional Firefighters
California Teamsters Public Affairs Council
DIGEST : This bill deletes 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
CONTINUED
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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. (Section
4616 of the Labor Code)
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. 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:
1. The worker's employer offers non-occupational group
health coverage.
2. The doctor is the worker's regular physician, as
specified, and has previously directed his/her medical
treatment and retains his/her medical records.
3. 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.
4. Prior to the injury the worker's doctor agrees to be
predesignated and treat the worker in case of work
injuries or illnesses.
5. Prior to the injury the worker provides his/her employer
the following in writing:
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A. Notice that he/she wants their personal doctor to
treat him/her for a work-related injury or illness.
B. 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 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 deletes 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 deletes 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
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
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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 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, 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 medical provider network.
This bill preserves 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. Section 4600
of the Labor Code, required the Division of Workers'
Compensation 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 Division
of Workers' Compensation does not believe it has the
information needed to produce such a report, nor does it
have the funds to do it.
Prior Legislation
SB 1338 (Migden) of 2008 sought to retain in law the right
to predesignation by deleting the December 31, 2009 sunset.
The bill was vetoed. In his veto message, the Governor
stated: "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), Chapter 819, Statutes of 2006, extended the
sunset date on the right of an employee to predesignate
their personal physician from April 30, 2007 to December
31, 2009.
FISCAL EFFECT : Appropriation: No Fiscal Com.: No
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Local: No
SUPPORT : (Verified 3/25/09)
California Labor Federation, AFL-CIO (co-source)
California Professional Firefighters (co-source)
California Teamsters Public Affairs Council (co-source)
Amalgamated Transit Union
American Federation of State, County and Municipal
Employees, AFL-CIO
California Conference of Machinists
California Medical Association
California Nurses Association
California School Employees Association, AFL-CIO
California State Council of Laborers
Engineers and Scientists of California
Glendale City Employees Association
IFPTE Local 21
International Longshore and Warehouse Union
Kaiser Permanente Medical Care Group
National Nurses Organizing Committee
Organization of SMUD Employees
Peace Officers Research Association of California
San Bernardino Public Employees Association
San Diego County Court Employees Association
San Luis Obispo County Employees Association
Santa Rosa City Employees Association
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 : (Verified 3/25/09)
Acclamation Insurance Management Services
Alpha Fund
American Fence Contractors' Association, California Chapter
California Association of Joint Powers Authorities
California Chamber of Commerce
California Coalition on Workers' Compensation
California Fence Contractors' Association
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California Manufacturers and Technology Association
California Special Districts Association
California State Association of Counties
CSAC-Excess Insurance Authority
Engineering Contractors' Association
Flasher/Barricade Association
League of California Cities
Marin Builders' Exchange
Regional Council of Rural Counties
ARGUMENTS IN SUPPORT : 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
the 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 relationship with, yet
employee satisfaction with the workers' compensation system
was much higher.
ARGUMENTS IN OPPOSITION : 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
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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 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.
AGB:mw 3/26/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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