BILL ANALYSIS
SB 186
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Date of Hearing: July 8, 2009
ASSEMBLY COMMITTEE ON INSURANCE
Jose Solorio, Chair
SB 186 (DeSaulnier) - As Introduced: February 17, 2009
SENATE VOTE : 29-10
SUBJECT : Workers' Compensation: Predesignation of Personal
Physician
SUMMARY : Removes the sunset date on the law that authorizes a
worker to predesignate his or her personal treating physician as
the treating physician in the event of a workplace injury.
EXISTING LAW :
1)Establishes a comprehensive system of workers' compensation
benefits, including medical benefits, for workers who are
injured on the job.
2)Allows the employer to select the treating physician for the
first 30 days after an injury, and, if the employer has
established a Medical Provider Network (MPN), allows the
employer to require injured employees to obtain treatment
within the MPN at all times.
3)Requires treatment of work-related injuries to be in
conformity with the American College of Occupational and
Environmental Medicine (ACOEM) Guidelines, or such other
guidelines as the Administrative Director (AD) of the Division
of Workers' Compensation may adopt.
4)Establishes a comprehensive system to adjudicate medical
treatment disputes, including utilization review that is
intended to ensure that treatment is provided in conformity
with the applicable treatment guidelines.
5)Authorizes an employee to "predesignate" a personal treating
physician who is authorized, in the event that employee is
injured on the job, to be the treating physician within the
first 30 days after the injury, and indefinitely even if the
employer has established an MPN.
6)Limits the right to predesignate a personal treating physician
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by:
a) Authorizing predesignation only by employees whose
employer offers group health insurance;
b) Requiring that a predesignated physician be a licensed
physician and surgeon who is the employee's primary care
physician who has previously directed the patient's care
and who maintains the patient's medical records and
history.
7)Provides that the predesignated physician may make all
appropriate referrals to other providers who are within the
employer-provided nonoccupational health insurance program.
8)Provides that any disputes that arise about the
appropriateness of medical treatment recommended by a
predesignated physician, or another provider to whom the
injured worker was referred by the predesignated physician, be
resolved within the dispute resolution system applicable to
the nonoccupational group health insurance program provided by
the employer.
FISCAL EFFECT : The bill is tagged as "nonfiscal," although
some employers have argued there is a cost implication for a
workers' compensation program. If this argument is correct,
there could be costs to the state's workers' compensation
program. Proponents disagree with this argument (see comment 1,
below).
COMMENTS :
1)Purpose: The Author introduced this bill to ensure that
employees have the right to select their own regular doctor as
their provider of choice in the event of a workplace injury.
The Author and sponsors believe that medical treatment will be
more effective if provided by a doctor who is familiar with
the patient, and who the patient trusts. In support of this
argument, the sponsors point to a study by the Public Policy
Institute of California that concluded that employee
satisfaction was higher and costs were no different for
employee's who predesignated their physician.
2)Referrals by the Predesignated Physician: According to the
opposition, one of the primary issues they have with the bill
is the element of current law that allows a predesignated
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physician to refer to specialists outside of the MPN. The
MPN, in the view of most employers, is one of the primary ways
that the 2004 reforms enacted effective cost controls. The
opponents believe for the same reasons articulated by the
sponsors that it is a good thing for an injured worker to see
their own, regular treating physician. However, the employee
does not have that same relationship with physicians to whom
they will be referred, and the opposition believes that
referrals should be within the MPN. Without that
modification, they oppose repeal of the sunset.
3)Dispute Resolution Concerns: Some of the opponents are
additionally concerned that disputes about medical treatment
will not be properly resolved, and the results will be
increased costs. They believe it is unclear whether the ACOEM
Guidelines and other approved guidelines apply or, in a case
where the group health insurance is provided by an HMO, the
Knox-Keene Health Care Service Plan rules apply. Further, the
opposition is concerned that even if ACOEM and other approved
guidelines do apply, the group health doctors who would be
resolving disputes are not familiar with the workers'
compensation rules. According to an informal analysis from
the DMHC, which indicates it has not yet had a workers'
compensation-related request for independent medical review
(IMR), only a patient who is denied treatment is eligible
under the Knox-Keene rules to request an IMR. Thus, it is
unclear whether an employer can even seek an IMR if it
believes a recommended treatment is not appropriate. Further,
because the Labor Code provides that "all" disputes involving
predesignated physicians are to be resolved through the
nonoccupational health insurance system, it is not clear
whether or how an employer could seek review of treatment to
which it objects. Without clarifying these problems, the
employers are opposed to repealing the sunset date.
REGISTERED SUPPORT / OPPOSITION :
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
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California Applicants' Attorneys Association (CAAA)
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)
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)
Analysis Prepared by : Mark Rakich / INS. / (916) 319-2086