BILL ANALYSIS �
AB 1687
Page 1
ASSEMBLY THIRD READING
AB 1687 (Fong)
As Amended March 12, 2012
Majority vote
INSURANCE 9-3 APPROPRIATIONS 12-5
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|Ayes:|Solorio, Bradford, |Ayes:|Fuentes, Blumenfield, |
| |Charles Calderon, Carter, | |Bradford, Charles |
| |Feuer, Hayashi, Skinner, | |Calderon, Campos, Davis, |
| |Torres, Wieckowski | |Gatto, Hall, Hill, Lara, |
| | | |Mitchell, Solorio |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Hagman, Beth Gaines, |Nays:|Harkey, Donnelly, |
| |Olsen | |Nielsen, Norby, Wagner |
| | | | |
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SUMMARY : Requires an employer or insurer to provide an
explanation of options for objecting to decisions to delay, deny
or modify medical treatment recommended by a treating physician,
and provides for compensation for attorneys in connection with
enforcing future medical treatment orders. Specifically, this
bill :
1)Requires, in connection with a utilization review (UR)
decision to delay, deny or modify medical treatment
recommended by a treating physician, that an employer or
insurer include a clear and concise explanation of the
available options for objecting to the delay, denial or
modification.
2)Requires the explanation to be in no less than 12-point bold
type on the first page of the communication to the injured
employee.
3)Authorizes the payment of reasonable attorney's fees where a
dispute arises concerning medical treatment where there has
been an award of future medical treatment and the applicant
has employed an attorney to enforce his or her rights.
EXISTING LAW :
AB 1687
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1)Provides for a comprehensive system of workers' compensation
benefits for workers who are injured on the job, including
medical benefits.
2)Establishes a formal process, known as UR, to resolve disputes
concerning the appropriateness of medical treatment being
recommended for an injured worker.
3)Provides generally that attorneys representing injured workers
are paid as a percentage of the permanent disability award,
but does not expressly provide for compensation in
medical-only or in future medical cases.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, minor absorbable costs to the Department of
Industrial Relations. Potentially minor increase of workers'
compensation insurance premiums due to the added costs
associated with the relatively few challenges to the relatively
few denials.
COMMENTS :
Purpose . According to the author, this bill is designed to
provide injured workers more information about how to navigate
the workers' compensation system in the event treatment
recommended by their treating physician is delayed, denied, or
modified, and to establish an appropriate incentive for
attorneys to take on "future medical" cases when the injured
worker requires the assistance of counsel.
Future medical awards . It is common in a workers' compensation
case to enter into settlement agreements that resolve disability
and retraining and other issues, but leave future medical
benefits open. This occurs when the parties are unable or
unwilling to make reasonable guesses about future medical needs.
That uncertainty, however, is not and should not be a barrier
to settlement of all other issues. This is particularly true
when there is a recognition that future medical needs may last
for years or for a lifetime.
It is unfortunately true that disputes can arise long after all
other matters have been resolved, often years after an attorney
has handled the case. In these circumstances, it is frequently
difficult or impossible for an injured worker to find an
AB 1687
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attorney to assist in enforcing the award. If the employer or
insurer behavior is egregious enough, there is the potential
that attorney's fees can be taken from penalties imposed, but in
the usual case, there is no provision for attorney's fees. This
bill is designed to address this issue.
Opposition . Employers and insurers are opposed to the bill,
arguing that the additional notification requirements are unduly
complicating and costly additions to a UR system that is
performing a valuable function of preventing inappropriate
treatment that is not evidence-based, and which forces treating
physicians to practice evidence-based medicine because the
failure to provide proper documentation for treatment requests
will result in delays due simply to inadequate medical
information. They point out that there are already enforcement
provisions for unreasonable delays, denials or modifications,
but that good faith use of the UR system should not be made more
costly and burdensome. They argue that this bill creates more
frictional costs of the very sort we are trying to eliminate.
With respect to the attorney's fees provision, they argue that
it will add costs to the system, and that the Division of
Workers' Compensation already has an Information and Assistance
Unit located in 24 places throughout California to help injured
workers in these sorts of cases.
Analysis Prepared by : Mark Rakich / INS. / (916) 319-2086
FN: 0003615