This bill contains the results of the conference committee convened to improve the workers compensation system.
ANALYSIS : Workers' compensation, implemented in California in 1913, is a no-fault system, entitling workers to compensation for illness or injury arising out of and in the course of work duties, regardless of the blame which might otherwise be placed on the employer or the employee. The workers' compensation system is premised on a bargain between employers and employees: employees are supposed to receive benefits for on-the-job injuries and, in return, the benefits are the exclusive remedy for injured employees against their employer, even when the employer negligently caused the injury. There are five basic types of workers' compensation benefits available, depending on the nature and severity of the worker's injury: (1) medical care; (2) temporary disability benefits; (3) permanent disability; (4) vocational rehabilitation services; and, (5) death benefits.
Briefly, the bill's provisions (1) restore user funding and specify use of funding for return to work program; (2) specify eligibility for return to work program; (3) repeals duplicate supplemental job displacement benefit language; (4) restore vocational rehabilitation program for pre-2004 injuries; (5) authorize collectively bargained projects on health care integration; (6) require impartial findings of fact; (7) fully eliminate rebuttable presumption for predesignated personal physician; (8) specify payment procedures for medical care; (9) revise procedure for obtaining qualified medical evaluation; (10) authorize provider medical networks, implemented under regulations of Administrative Director of Division of Workers' Compensation; (11) partially repeal spinal surgery second opinion program; (12) establish a system of independent medical review; (13) deem approval as medical provider networks of health maintenance organizations and health are organizations exhibiting competency in occupational and nonoccupational medicine; (14) limit most temporary disability payments to 104 weeks; (15) provide for capped medical lien filing fee from those filing liens; (16) provide for immediate authorized medical treatment to all workers filing claim forms for occupational injury; (17) revise penalty amounts in cases of unreasonable delay or denial of care or benefits; (18) provide for administrative penalties of up to $400,000 for employers knowingly violating delay/denial laws as general business practice; (19) require that insurers conduct review of injury and illness prevention program of all new insured employers with experience modification factors of 2.0 or more; (20) replace present law on apportionment with statement that apportionment of permanent disability is based on causation; (21) require physicians evaluating permanent disability to assess percentage of disability due to work; (22) makes employer liable only for portion of disability directly caused by injury, restricts accumulated percentage disability for any body region to 100% over lifetime; (23) require a study of the insurance marketplace and rate effects from legislative reform; and (24) allow for predesignated physician within group health network.