Changes to California Workers’ Compensation law take effect July 1, 2013
As of July 1, 2013, medical treatment for a work-related injury will be controlled by employers more than ever before. With the passing of Senate Bill (SB) 863, California’s latest Workers’ Compensation “reform,” new deadlines and treatment requests will be watched closely. The bill makes wide-ranging changes to California’s workers’ compensation system, including increased benefits to injured workers and cost-saving efficiencies.
However, mistakes and omissions give insurance companies justification to deny a request for medical care.
The following are ways to help you, or the Union members you represent, navigate this process:
- In order to receive medical treatment, you must file a Workers’ Compensation Claim Form. You are entitled to medical treatment within 24 hours of reporting an injury.
- If you have properly pre-designated your own doctor (must be done in writing before an injury), you may be treated by that physician from the date of injury until treatment is concluded.
- If you have not pre-designated a doctor, and if your employer provides Workers’ Compensation medical care through a Medical Provider Network (MPN), you must select a treating doctor from the network’s approved provider list. The doctor chosen from this list could have a significant impact on your case. If your employer doesn’t participate in the MPN, you may select any doctor (who is willing to provide medical care in the Workers’ Compensation system) after 30 days from the employer’s receipt of your Workers’ Compensation Claim Form.
- It is important that your doctor understands Workers’ Compensation laws, reporting requirements and the process necessary to request medical treatment.
- The treating physician must request medical treatment by using a specific Request for Authorization Form. This form must be completed to the last detail or it will be returned as “incomplete.”
- Treatment requests are subject to Utilization Review (UR), a process in which insurance companies can approve, delay, modify or deny treatment. If the request is not approved, you have only 30 days from the date of the UR decision to request an Independent Medical Review (IMR) of the decision. The IMR will be conducted by an IMR organization designated by the California Department of Insurance. Following July 1, 2013, this is true for all Workers’ Compensation cases, regardless of date of injury.
- There are new home healthcare limitations involving service provider requirements, prescriptions, fee schedules, reporting requirements and payment for services.
- Keep in mind that you may also be entitled to medical treatment for “consequences” of your injury, including internal medical and/or emotional symptoms or complaints.
With all of the changes stemming from SB 863, if you, or the Union members you represent, need the help of an experienced, knowledgeable Workers’ Compensation lawyer, please contact your labor law counsel for a referral.
By Lisl Duncan | July 1, 2013