AB 2732, as amended, Committee on Insurance. Workers’ compensation.
(1) Existing law establishes a workers’ compensation system, administered by the Administrative Director of the Division of Workers’ Compensation, to compensate an employee for injuries sustained in the course of his or her employment. Existing law generally provides for the reimbursement of medical providers for services rendered in connection with the treatment of a worker’s injury, and requires an employer to establish a medical treatment utilization review process, in compliance with specified requirements. Existing law provides for an independent medical review process to resolve disputes over a utilization review decision for injuries occurring on or after January 1, 2013, and for any decision that is communicated to the requesting physician on or after July 1, 2013, regardless of the date of injury. Under existing law, as part of its notification to the employee regarding an initial utilization review decision that denies, modifies, or delays a treatment recommendation, an employer is required to provide the employee with a one-page form prescribed by the administrative director, and an addressed envelope, which the employee may return to the administrative director or the administrative director’s designee to initiate an independent medical review. Under existing law, an employer is required to include on this form any information required by the administrative director to facilitate the completion of the independent medical review. Existing law specifies the required contents of the form.
This bill would revise the requirements applicable to utilization review procedures, by changing the maximum length of the above-described form to 2 pages.
(2) Existing law authorizes the Workers’ Compensation Appeals Board to determine and allow as liens against any sum to be paid as compensation, certain amounts, including, but not limited to, reasonable medical treatment expenses, except those disputes subject to independent medical review or independent bill review.
This bill would include in those amounts that the board is authorized to allow as liens certain medical-legal expenses to which the employee is entitled under a specified provision for the purpose of proving or disproving a disputed claim.
(3) Existing law requires that a lien claimant in a workers’ compensation matter is entitled to an order or award for reimbursement of a lien filing fee or lien activation fee, together with interest at the rate allowed on civil judgments, if certain conditions are satisfied.
This bill would specify that these fees are to be paid by the employer of the injured worker.
(4) Existing law requires an order or award for payment of a lien for medical or hospital treatment in a workers’ compensation matter to be made for payment only to the person who was entitled to payment for the expenses for medical or hospital treatment at the time the expenses were incurred, and not to an assignee unless the person has ceased doing business in the capacity held at the time the expenses were incurred and has assigned all right, title, and interest in the remaining accounts receivable to the assignee.
This bill would authorize an assignment of that payment if the assignment was completed prior to January 1, 2013, or if it was required by a contract that became enforceable and irrevocable prior to January 1, 2013. The bill would state that this provision is declarative of existing law.
(5) Existing law authorizes an injured worker to institute proceedings for the collection of compensation, including vocational rehabilitation services, within 5 years after the date of the injury upon the ground that the original injury has caused new and further disability or that providing vocational rehabilitation services has become feasible because the employee’s medical condition has improved or because of other factors not capable of determination at the time the employer’s liability for vocational rehabilitation services otherwise terminated.
This bill would delete the provisions relating to vocational rehabilitation, but retain the authority of an injured worker to institute proceedings for the collection of compensation within 5 years after the date of the injury upon the ground that the original injury has caused new and further disability.
(6) Existing law authorizes the Workers’ Compensation Appeals Board to determine and allow as liens against any sum to be paid as compensation, certain amounts, including, but not limited to, reasonable medical treatment expenses, except those disputes subject to independent medical review or independent bill review.
This bill would include in those amounts that the board is authorized to allow as liens certain medical-legal expenses to which the employee is entitled under a specified provision for the purpose of proving or disproving a disputed claim.
(7) Existing law gives the Workers’ Compensation Appeals Board jurisdiction to adjudicate claims relating to workers’ compensation, and authorizes the administrative director to establish a priority calendar for issues requiring an expedited hearing and decision. The issues for which an expedited hearing may be held include a medical treatment appointment or medical-legal examination.
end deleteThis bill would delete medical treatment appointments and medical-legal examinations from the list of issues qualifying for an expedited hearing.
end deleteVote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 4600 of the Labor Code is amended to
2read:
(a) Medical, surgical, chiropractic, acupuncture, and
2hospital treatment, including nursing, medicines, medical and
3surgical supplies, crutches, and apparatuses, including orthotic and
4prosthetic devices and services, that is reasonably required to cure
5or relieve the injured worker from the effects of his or her injury
6shall be provided by the employer. In the case of his or her neglect
7or refusal reasonably to do so, the employer is liable for the
8reasonable expense incurred by or on behalf of the employee in
9providing treatment.
10(b) As used in this division and notwithstanding any other law,
11medical treatment that is reasonably required to cure or relieve the
12injured worker from the
effects of his or her injury means treatment
13that is based upon the guidelines adopted by the administrative
14director pursuant to Section 5307.27.
15(c) Unless the employer or the employer’s insurer has
16established or contracted with a medical provider network as
17provided for in Section 4616, after 30 days from the date the injury
18is reported, the employee may be treated by a physician of his or
19her own choice or at a facility of his or her own choice within a
20reasonable geographic area. A chiropractor shall not be a treating
21physician after the employee has received the maximum number
22of chiropractic visits allowed by subdivision (c) of Section 4604.5.
23(d) (1) If an employee has notified his or her employer in
24writing prior to the date of injury that he or she has a
personal
25physician, the employee shall have the right to be treated by that
26physician from the date of injury if the employee has health care
27coverage for nonoccupational injuries or illnesses on the date of
28injury in a plan, policy, or fund as described in subdivisions (b),
29(c), and (d) of Section 4616.7.
30(2) For purposes of paragraph (1), a personal physician shall
31meet all of the following conditions:
32(A) Be the employee’s regular physician and surgeon, licensed
33pursuant to Chapter 5 (commencing with Section 2000) of Division
342 of the Business and Professions Code.
35(B) Be the employee’s primary care physician and has
36previously directed the medical treatment of the employee, and
37who retains the employee’s
medical records, including his or her
38medical history. “Personal physician” includes a medical group,
39if the medical group is a single corporation or partnership
40composed of licensed doctors of medicine or osteopathy, which
P5 1operates an integrated multispecialty medical group providing
2comprehensive medical services predominantly for
3nonoccupational illnesses and injuries.
4(C) The physician agrees to be predesignated.
5(3) If the employee has health care coverage for nonoccupational
6injuries or illnesses on the date of injury in a health care service
7plan licensed pursuant to Chapter 2.2 (commencing with Section
81340) of Division 2 of the Health and Safety Code, and the
9employer is notified pursuant to paragraph (1), all medical
10treatment, utilization review of medical treatment, access
to
11medical treatment, and other medical treatment issues shall be
12governed by Chapter 2.2 (commencing with Section 1340) of
13Division 2 of the Health and Safety Code. Disputes regarding the
14provision of medical treatment shall be resolved pursuant to Article
155.55 (commencing with Section 1374.30) of Chapter 2.2 of
16Division 2 of the Health and Safety Code.
17(4) If the employee has health care coverage for nonoccupational
18injuries or illnesses on the date of injury in a group health insurance
19policy as described in Section 4616.7, all medical treatment,
20utilization review of medical treatment, access to medical
21treatment, and other medical treatment issues shall be governed
22by the applicable provisions of the Insurance Code.
23(5) The insurer may require prior authorization of any
24nonemergency
treatment or diagnostic service and may conduct
25reasonably necessary utilization review pursuant to Section 4610.
26(6) An employee shall be entitled to all medically appropriate
27referrals by the personal physician to other physicians or medical
28providers within the nonoccupational health care plan. An
29employee shall be entitled to treatment by physicians or other
30medical providers outside of the nonoccupational health care plan
31pursuant to standards established in Article 5 (commencing with
32Section 1367) of Chapter 2.2 of Division 2 of the Health and Safety
33Code.
34(e) (1) When at the request of the employer, the employer’s
35insurer, the administrative director, the appeals board, or a workers’
36compensation administrative law judge, the employee submits to
37examination
by a physician, he or she shall be entitled to receive,
38in addition to all other benefits herein provided, all reasonable
39expenses of transportation, meals, and lodging incident to reporting
40for the examination, together with one day of temporary disability
P6 1indemnity for each day of wages lost in submitting to the
2examination.
3(2) Regardless of the date of injury, “reasonable expenses of
4transportation” includes mileage fees from the employee’s home
5to the place of the examination and back at the rate of twenty-one
6cents ($0.21) a mile or the mileage rate adopted by the Director
7of Human Resources pursuant to Section 19820 of the Government
8Code, whichever is higher, plus any bridge tolls. The mileage and
9tolls shall be paid to the employee at the time he or she is given
10notification of the time and place of the examination.
11(f) When at the request of the employer, the employer’s insurer,
12the administrative director, the appeals board, or a workers’
13compensation administrative law judge, an employee submits to
14examination by a physician and the employee does not proficiently
15speak or understand the English language, he or she shall be
16entitled to the services of a qualified interpreter in accordance with
17conditions and a fee schedule prescribed by the administrative
18director. These services shall be provided by the employer. For
19purposes of this section, “qualified interpreter” means a language
20interpreter certified, or deemed certified, pursuant to Article 8
21(commencing with Section 11435.05) of Chapter 4.5 of Part 1 of
22Division 3 of Title 2 of, or Section 68566 of, the Government
23Code.
24(g) If
the injured employee cannot effectively communicate
25with his or her treating physician because he or she cannot
26proficiently speak or understand the English language, the injured
27employee is entitled to the services of a qualified interpreter during
28medical treatment appointments. To be a qualified interpreter for
29purposes of medical treatment appointments, an interpreter is not
30required to meet the requirements of subdivision (f), but shall meet
31any requirements established by rule by the administrative director
32that are substantially similar to the requirements set forth in Section
331367.04 of the Health and Safety Code. The administrative director
34shall adopt a fee schedule for qualified interpreter fees in
35accordance with this section. Upon request of the injured employee,
36the employer or insurance carrier shall pay for interpreter services.
37An employer shall not be required to pay for the
services of an
38interpreter who is not certified or is provisionally certified by the
39person conducting the medical treatment or examination unless
40either the employer consents in advance to the selection of the
P7 1individual who provides the interpreting service or the injured
2worker requires interpreting service in a language other than the
3languages designated pursuant to Section 11435.40 of the
4Government Code.
5(h) Home health care services shall be provided as medical
6treatment only if reasonably required to cure or relieve the injured
7employee from the effects of his or her injury and prescribed by
8a physician and surgeon licensed pursuant to Chapter 5
9(commencing with Section 2000) of Division 2 of the Business
10and Professions Code, and subject to Section 5307.1 or 5703.8.
11The employer shall not be liable for home health care services that
12
are provided more than 14 days prior to the date of the employer’s
13receipt of the physician’s prescription.
Section 4610.5 of the Labor Code is amended to read:
(a) This section applies to the following disputes:
16(1) Any dispute over a utilization review decision regarding
17treatment for an injury occurring on or after January 1, 2013.
18(2) Any dispute over a utilization review decision if the decision
19is communicated to the requesting physician on or after July 1,
202013, regardless of the date of injury.
21(b) A dispute described in subdivision (a) shall be resolved only
22in accordance with this section.
23(c) For purposes of this section and Section 4610.6, the
24following
definitions apply:
25(1) “Disputed medical treatment” means medical treatment that
26has been modified, delayed, or denied by a utilization review
27decision.
28(2) “Medically necessary” and “medical necessity” mean
29medical treatment that is reasonably required to cure or relieve the
30injured employee of the effects of his or her injury and based on
31the following standards, which shall be applied in the order listed,
32allowing reliance on a lower ranked standard only if every higher
33ranked standard is inapplicable to the employee’s medical
34condition:
35(A) The guidelines adopted by the administrative director
36pursuant to Section 5307.27.
37(B) Peer-reviewed
scientific and medical evidence regarding
38the effectiveness of the disputed service.
39(C) Nationally recognized professional standards.
40(D) Expert opinion.
P8 1(E) Generally accepted standards of medical practice.
2(F) Treatments that are likely to provide a benefit to a patient
3for conditions for which other treatments are not clinically
4efficacious.
5(3) “Utilization review decision” means a decision pursuant to
6Section 4610 to modify, delay, or deny, based in whole or in part
7on medical necessity to cure or relieve, a treatment
8recommendation or recommendations by a physician prior to,
9retrospectively, or
concurrent withbegin insert,end insert the provision of medical
10treatment services pursuant to Section 4600 or subdivision (c) of
11Section 5402.
12(4) Unless otherwise indicated by context, “employer” means
13the employer, the insurer of an insured employer, a claims
14administrator, or a utilization review organization, or other entity
15acting on behalf of any of them.
16(d) If a utilization review decision denies, modifies, or delays
17a treatment recommendation, the employee may request an
18independent medical review as provided by this section.
19(e) A utilization review decision may be reviewed or appealed
20only by independent medical review pursuant to
this section.
21Neither the employee nor the employer shall have any liability for
22medical treatment furnished without the authorization of the
23employer if the treatment is delayed, modified, or denied by a
24utilization review decision unless the utilization review decision
25is overturned by independent medical review in accordance with
26this section.
27(f) As part of its notification to the employee regarding an initial
28utilization review decision that denies, modifies, or delays a
29treatment recommendation, the employer shall provide the
30employee with a form not to exceed two pages, prescribed by the
31administrative director, and an addressed envelope, which the
32employee may return to the administrative director or the
33administrative director’s designee to initiate an independent
34medical review. The employer shall include on the form
any
35information required by the administrative director to facilitate the
36completion of the independent medical review. The form shall
37also include all of the following:
38(1) Notice that the utilization review decision is final unless the
39employee requests independent medical review.
P9 1(2) A statement indicating the employee’s consent to obtain any
2necessary medical records from the employer or insurer and from
3any medical provider the employee may have consulted on the
4matter, to be signed by the employee.
5(3) Notice of the employee’s right to provide information or
6documentation, either directly or through the employee’s physician,
7regarding the following:
8(A) The treating physician’s recommendation indicating that
9the disputed medical treatment is medically necessary for the
10employee’s medical condition.
11(B) Medical information or justification that a disputed medical
12treatment, on an urgent care or emergency basis, was medically
13necessary for the employee’s medical condition.
14(C) Reasonable information supporting the employee’s position
15that the disputed medical treatment is or was medically necessary
16for the employee’s medical condition, including all information
17provided to the employee by the employer or by the treating
18physician, still in the employee’s possession, concerning the
19employer’s or the physician’s decision regarding the disputed
20medical treatment, as well as any additional material that the
21employee
believes is relevant.
22(g) The independent medical review process may be terminated
23at any time upon the employer’s written authorization of the
24disputed medical treatment.
25(h) (1) The employee may submit a request for independent
26medical review to the division no later than 30 days after the
27service of the utilization review decision to the employee.
28(2) If at the time of a utilization review decision the employer
29is also disputing liability for the treatment for any reason besides
30medical necessity, the time for the employee to submit a request
31for independent medical review to the administrative director or
32administrative director’s designee is extended to 30 days after
33service of a notice to the
employee showing that the other dispute
34of liability has been resolved.
35(3) If the employer fails to comply with subdivision (f) at the
36time of notification of its utilization review decision, the time
37limitations for the employee to submit a request for independent
38medical review shall not begin to run until the employer provides
39the required notice to the employee.
P10 1(4) A provider of emergency medical treatment when the
2employee faced an imminent and serious threat to his or her health,
3including, but not limited to, the potential loss of life, limb, or
4other major bodily function, may submit a request for independent
5medical review on its own behalf. A request submitted by a
6provider pursuant to this paragraph shall be submitted to the
7administrative
director or administrative director’s designee within
8the time limitations applicable for an employee to submit a request
9for independent medical review.
10(i) An employer shall not engage in any conduct that has the
11effect of delaying the independent review process. Engaging in
12that conduct or failure of the employer to promptly comply with
13this section is a violation of this section and, in addition to any
14other fines, penalties, and other remedies available to the
15administrative director, the employer shall be subject to an
16administrative penalty in an amount determined pursuant to
17regulations to be adopted by the administrative director, not to
18exceed five thousand dollars ($5,000) for each day that proper
19notification to the employee is delayed. The administrative
20penalties shall be paid to the Workers’ Compensation
21Administration
Revolving Fund.
22(j) For purposes of this section, an employee may designate a
23parent, guardian, conservator, relative, or other designee of the
24employee as an agent to act on his or her behalf. A designation of
25an agent executed prior to the utilization review decision shall not
26be valid. The requesting physician may join with or otherwise
27assist the employee in seeking an independent medical review,
28and may advocate on behalf of the employee.
29(k) The administrative director or his or her designee shall
30expeditiously review requests and immediately notify the employee
31and the employer in writing as to whether the request for an
32independent medical review has been approved, in whole or in
33part, and, if not approved, the reasons therefor. If there appears to
34be any medical
necessity issue, the dispute shall be resolved
35pursuant to an independent medical review, except that, unless the
36employer agrees that the case is eligible for independent medical
37review, a request for independent medical review shall be deferred
38if at the time of a utilization review decision the employer is also
39disputing liability for the treatment for any reason besides medical
40necessity.
P11 1(l) Upon notice from the administrative director that an
2independent review organization has been assigned, the employer
3shall provide to the independent medical review organization all
4of the following documents within 10 days of notice of assignment:
5(1) A copy of all of the employee’s medical records in the
6possession of the employer or under the control of the employer
7relevant to each
of the following:
8(A) The employee’s current medical condition.
9(B) The medical treatment being provided by the employer.
10(C) The disputed medical treatment requested by the employee.
11(2) A copy of all information provided to the employee by the
12employer concerning employer and provider decisions regarding
13the disputed treatment.
14(3) A copy of any materials the employee or the employee’s
15provider submitted to the employer in support of the employee’s
16request for the disputed treatment.
17(4) A copy of any other relevant documents or information used
18
by the employer or its utilization review organization in
19determining whether the disputed treatment should have been
20provided, and any statements by the employer or its utilization
21review organization explaining the reasons for the decision to
22deny, modify, or delay the recommended treatment on the basis
23of medical necessity. The employer shall concurrently provide a
24copy of the documents required by this paragraph to the employee
25and the requesting physician, except that documents previously
26provided to the employee or physician need not be provided again
27if a list of those documents is provided.
28(m) Any newly developed or discovered relevant medical
29records in the possession of the employer after the initial documents
30are provided to the independent medical review organization shall
31be forwarded immediately to the independent
medical review
32organization. The employer shall concurrently provide a copy of
33medical records required by this subdivision to the employee or
34the employee’s treating physician, unless the offer of medical
35records is declined or otherwise prohibited by law. The
36confidentiality of medical records shall be maintained pursuant to
37applicable state and federal laws.
38(n) If there is an imminent and serious threat to the health of
39the employee, as specified in subdivision (c) of Section 1374.33
40of the Health and Safety Code, all necessary information and
P12 1documents required by subdivision (l) shall be delivered to the
2independent medical review organization within 24 hours of
3approval of the request for review.
4(o) The employer shall promptly
issue a notification to the
5employee, after submitting all of the required material to the
6independent medical review organization, that lists documents
7submitted and includes copies of material not previously provided
8to the employee or the employee’s designee.
Section 4903 of the Labor Code is amended to read:
The appeals board may determine, and allow as liens
11against any sum to be paid as compensation, any amount
12determined as hereinafter set forth in subdivisions (a) through (i).
13If more than one lien is allowed, the appeals board may determine
14the priorities, if any, between the liens allowed. The liens that may
15be allowed hereunder are as follows:
16(a) A reasonable attorney’s fee for legal services pertaining to
17any claim for compensation either before the appeals board or
18before any of the appellate courts, and the reasonable disbursements
19in connection therewith. No fee for legal services shall be awarded
20to any representative who is not an attorney, except with respect
21to those
claims for compensation for which an application, pursuant
22to Section 5501, has been filed with the appeals board on or before
23December 31, 1991, or for which a disclosure form, pursuant to
24Section 4906, has been sent to the employer, or insurer or
25third-party administrator, if either is known, on or before December
2631, 1991.
27(b) The reasonable expense incurred by or on behalf of the
28injured employee, as provided by Article 2 (commencing with
29Section 4600), and to the extent the employee is entitled to
30reimbursement under Section 4621, medical-legal expenses as
31provided by Article 2.5 (commencing with Section 4620) of
32Chapter 2 of Part 2, except those disputes subject to independent
33medical review or independent bill review.
34(c) The reasonable value of the living expenses of an
injured
35employee or of his or her dependents, subsequent to the injury.
36(d) The reasonable burial expenses of the deceased employee,
37not to exceed the amount provided for by Section 4701.
38(e) The reasonable living expenses of the spouse or minor
39children of the injured employee, or both, subsequent to the date
40of the injury, where the employee has deserted or is neglecting his
P13 1or her family. These expenses shall be allowed in the proportion
2that the appeals board deems proper, under application of the
3spouse, guardian of the minor children, or the assignee, pursuant
4to subdivision (a) of Section 11477 of the Welfare and Institutions
5Code, of the spouse, a former spouse, or minor children. A
6collection received as a result of a lien against a workers’
7compensation award imposed
pursuant to this subdivision for
8payment of child support ordered by a court shall be credited as
9provided in Section 695.221 of the Code of Civil Procedure.
10(f) The amount of unemployment compensation disability
11benefits that have been paid under or pursuant to the
12Unemployment Insurance Code in those cases where, pending a
13determination under this division there was uncertainty whether
14the benefits were payable under the Unemployment Insurance
15Code or payable hereunder; provided, however, that any lien under
16this subdivision shall be allowed and paid as provided in Section
174904.
18(g) The amount of unemployment compensation benefits and
19extended duration benefits paid to the injured employee for the
20same day or days for which he or she receives, or is entitled to
21receive,
temporary total disability indemnity payments under this
22division; provided, however, that any lien under this subdivision
23shall be allowed and paid as provided in Section 4904.
24(h) The amount of family temporary disability insurance benefits
25that have been paid to the injured employee pursuant to the
26Unemployment Insurance Code for the same day or days for which
27that employee receives, or is entitled to receive, temporary total
28disability indemnity payments under this division, provided,
29however, that any lien under this subdivision shall be allowed and
30paid as provided in Section 4904.
31(i) The amount of indemnification granted by the California
32Victims of Crime Program pursuant to Article 1 (commencing
33with Section 13959) of Chapter 5 of Part 4 of Division 3 of Title
342 of the
Government Code.
Section 4903.07 of the Labor Code is amended to read:
(a) A lien claimant shall be entitled to an order or
37award for reimbursement from the employer of a lien filing fee or
38lien activation fee, together with interest at the rate allowed on
39civil judgments, only if all of the following conditions are satisfied:
P14 1(1) Not less than 30 days before filing the lien for which the
2filing fee was paid or filing the declaration of readiness for which
3the lien activation fee was paid, the lien claimant has made written
4demand for settlement of the lien claim for a clearly stated sum
5which shall be inclusive of all claims of debt, interest, penalty, or
6other claims potentially recoverable on the lien.
7(2) The defendant fails to accept the settlement demand in
8writing within 20 days of receipt of the demand for settlement, or
9within any additional time as may be provide by the written
10demand.
11(3) After submission of the lien dispute to the appeals board or
12an arbitrator, a final award is made in favor of the lien claimant
13of a specified sum that is equal to or greater than the amount of
14the settlement demand. The amount of the interest and filing fee
15or lien activation fee shall not be considered in determining whether
16the award is equal to or greater than the demand.
17(b) This section shall not preclude an order or award of
18reimbursement of the filing fee or activation fee pursuant to the
19express terms of an agreed disposition of a lien
dispute.
Section 4903.8 of the Labor Code is amended to read:
(a) (1) Any order or award for payment of a lien filed
22pursuant to subdivision (b) of Section 4903 shall be made for
23payment only to the person who was entitled to payment for the
24expenses as provided in subdivision (b) of Section 4903 at the time
25the expenses were incurred, and not to an assignee unless the
26person has ceased doing business in the capacity held at the time
27the expenses were incurred and has assigned all right, title, and
28
interest in the remaining accounts receivable to the assignee.
29(2) Paragraph (1) does not apply to an assignment that was
30completed prior to January 1, 2013, or that was required by a
31contract that became enforceable and irrevocable prior to January
321, 2013. This paragraph is declarative of existing law.
33(b) If there has been an assignment of a lien, either as an
34assignment of all right, title, and interest in the accounts receivable
35or as an assignment for collection, a true and correct copy of the
36assignment shall be filed and served.
37(1) If the lien is filed on or after January 1, 2013, and the
38assignment occurs before the filing of the lien, the copy of the
39assignment shall be served at the time the lien
is filed.
P15 1(2) If the lien is filed on or after January 1, 2013, and the
2assignment occurs after the filing of the lien, the copy of the
3assignment shall be served within 20 days of the date of the
4assignment.
5(3) If the lien is filed before January 1, 2013, the copy of the
6assignment shall be served by January 1, 2014, or with the filing
7of a declaration of readiness or at the time of a lien hearing,
8whichever is earliest.
9(c) If there has been more than one assignment of the same
10receivable or bill, the appeals board may set the matter for hearing
11on whether the multiple assignments constitute bad-faith actions
12or tactics that are frivolous, harassing, or intended to cause
13unnecessary delay or expense. If so found by
the appeals board,
14appropriate sanctions, including costs and attorney’s fees, may be
15awarded against the assignor, assignee, and their respective
16attorneys.
17(d) At the time of filing of a lien on or after January 1, 2013, or
18in the case of a lien filed before January 1, 2013, at the earliest of
19the filing of a declaration of readiness, a lien hearing, or January
201, 2014, supporting documentation shall be filed including one or
21more declarations under penalty of perjury by a natural person or
22persons competent to testify to the facts stated, declaring both of
23the following:
24(1) The services or products described in the bill for services
25or products were actually provided to the injured employee.
26(2) The billing
statement attached to the lien truly and accurately
27describes the services or products that were provided to the injured
28employee.
29(e) A lien submitted for filing on or after January 1, 2013, for
30expenses provided in subdivision (b) of Section 4903, that does
31not comply with the requirements of this section shall be deemed
32to be invalid, whether or not accepted for filing by the appeals
33board, and shall not operate to preserve or extend any time limit
34for filing of the lien.
35(f) This section shall take effect without regulatory action. The
36appeals board and the administrative director may promulgate
37regulations and forms for the implementation of this section.
Section 5410 of the Labor Code is amended to read:
Nothing in this chapter shall bar the right of any injured
40worker to institute proceedings for the collection of compensation
P16 1within five years after the date of the injury upon the ground that
2the original injury has caused new and further disability. The
3jurisdiction of the appeals board in these cases shall be a continuing
4jurisdiction within this period. This section does not extend the
5limitation provided in Section 5407.
Section 5502 of the Labor Code is amended to read:
(a) Except as provided in subdivisions (b) and (d), the
8hearing shall be held not less than 10 days, and not more than 60
9days, after the date a declaration of readiness to proceed, on a form
10prescribed by the appeals board, is filed. If a claim form has been
11filed for an injury occurring on or after January 1, 1990, and before
12January 1, 1994, an application for adjudication shall accompany
13the declaration of readiness to proceed.
14(b) The administrative director shall establish a priority calendar
15for issues requiring an expedited hearing and decision. A hearing
16shall be held and a determination as to the rights of the parties
17shall be made and filed within 30 days after the declaration of
18readiness to proceed is filed if the issues in dispute are any of the
19
following, provided that if an expedited hearing is requested, no
20other issue may be heard until the medical provider network dispute
21is resolved:
22(1) The employee’s entitlement to medical treatment pursuant
23to Section 4600, except for treatment issues determined pursuant
24to Sections 4610 and 4610.5.
25(2) Whether the injured employee is required to obtain treatment
26within a medical provider network.
27(3) The employee’s entitlement to, or the amount of, temporary
28disability indemnity payments.
29(4) The employee’s entitlement to compensation from one or
30more responsible employers when two or more employers dispute
31liability as among themselves.
32(5) Any other issues requiring an expedited hearing and
33determination as
prescribed in rules and regulations of the
34administrative director.
35(c) The administrative director shall establish a priority
36conference calendar for cases in which the employee is represented
37by an attorney and the issues in dispute are employment or injury
38arising out of employment or in the course of employment. The
39conference shall be conducted by a workers’ compensation
40administrative law judge within 30 days after the declaration of
P17 1readiness to proceed. If the dispute cannot be resolved at the
2conference, a trial shall be set as expeditiously as possible, unless
3good cause is shown why discovery is not complete, in which case
4status conferences shall be held at regular intervals. The case shall
5be set for trial when discovery is complete, or when the workers’
6compensation administrative law judge determines that the parties
7have had sufficient time in which to complete reasonable discovery.
8A determination as to the rights of the
parties shall be made and
9filed within 30 days after the trial.
10(d) (1) In all cases, a mandatory settlement conference, except
11a lien conference or a mandatory settlement lien conference, shall
12be conducted not less than 10 days, and not more than 30 days,
13after the filing of a declaration of readiness to proceed. If the
14dispute is not resolved, the regular hearing, except a lien trial, shall
15be held within 75 days after the declaration of readiness to proceed
16is filed.
17(2) The settlement conference shall be conducted by a workers’
18compensation administrative law judge or by a referee who is
19eligible to be a workers’ compensation administrative law judge
20or eligible to be an arbitrator under Section 5270.5. At the
21mandatory settlement conference, the referee or workers’
22compensation administrative law judge shall have the authority to
23resolve the dispute,
including the authority to approve a
24compromise and release or issue a stipulated finding and award,
25and if the dispute cannot be resolved, to frame the issues and
26stipulations for trial. The appeals board shall adopt any regulations
27needed to implement this subdivision. The presiding workers’
28compensation administrative law judge shall supervise settlement
29conference referees in the performance of their judicial functions
30under this subdivision.
31(3) If the claim is not resolved at the mandatory settlement
32conference, the parties shall file a pretrial conference statement
33noting the specific issues in dispute, each party’s proposed
34permanent disability rating, and listing the exhibits, and disclosing
35witnesses. Discovery shall close on the date of the mandatory
36settlement conference. Evidence not disclosed or obtained
37thereafter shall not be admissible unless the proponent of the
38evidence can demonstrate that it was not available or could not
39
have been discovered by the exercise of due diligence prior to the
40settlement conference.
P18 1(e) In cases involving the Director of Industrial Relations in his
2or her capacity as administrator of the Uninsured Employers Fund,
3this section shall not apply unless proof of service, as specified in
4paragraph (1) of subdivision (d) of Section 3716, has been filed
5with the appeals board and provided to the Director of Industrial
6Relations, valid jurisdiction has been established over the employer,
7and the fund has been joined.
8(f) Except as provided in subdivision (a) and in Section 4065,
9the provisions of this section shall apply irrespective of the date
10of injury.
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