BILL ANALYSIS �
AB 1687
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB 1687 (Fong)
As Amended June 18, 2012
Majority vote
-----------------------------------------------------------------
|ASSEMBLY: |47-24|(May 17, 2012) |SENATE: |22-12|(August 29, |
| | | | | |2012) |
-----------------------------------------------------------------
Original Committee Reference: INS.
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.
The Senate amendments :
1)Place the explanation requirement relating to the delay,
denial or modification of medical treatment into a different
code section.
2)Add a requirement that, in order to obtain attorney's fees
with respect to disputed medical treatment, the injured worker
must prevail in the dispute.
3)Limit the cases where the right to attorney's fees applies to
cases where there is a final award of permanent disability
benefits.
AS PASSED BY THE ASSEMBLY , 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.
AB 1687
Page 2
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.
FISCAL EFFECT : According to the Senate Appropriations
Committee, unknown, likely significant increase annually in
state workers' compensation costs; generally 55% from the
General Fund and 45% from special funds.
COMMENTS : 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.
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
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. The
bill is designed to address this issue.
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
AB 1687
Page 3
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: 0005073