At the Law offices of James E. Latimer and Associates, recently being asked about the recent notable changes to California Workers’ Compensation law that happened in the last few years. We have compiled the list of all notable changes for you below, as of September 2021.
- COVID-19 Presumption: In response to the COVID-19 pandemic, California implemented a presumption under Senate Bill 1159, which was signed into law on September 17, 2020. This presumption applies to certain workers, including first responders and healthcare workers, who contract COVID-19. It establishes a rebuttable presumption that COVID-19 is work-related, meaning that if an eligible worker contracts COVID-19, it is presumed to have occurred in the course of their employment, making them eligible for workers’ compensation benefits. However, this presumption can be rebutted by evidence to the contrary.
- Medical Provider Networks (MPNs): MPNs are networks of pre-approved medical providers that injured workers can seek treatment from. Recent updates to MPN requirements include increased transparency and accessibility requirements, such as providing clear and accessible information to injured workers about their MPN rights and options, and making MPN directories readily available. Additionally, changes have been made to the process for injured workers to change their treating physician within an MPN, including provisions for expedited changes under certain circumstances.
- Utilization Review (UR) and Independent Medical Review (IMR): UR and IMR are processes used to review and resolve disputes related to the medical treatment of injured workers. There have been ongoing updates and changes to these processes to improve their efficiency and effectiveness. For example, updates have been made to the UR process to ensure that treatment requests are reviewed in a timely manner, and changes have been implemented to the IMR process to address concerns related to the independence and qualifications of medical reviewers.
- Fee Schedule Updates: California periodically updates its fee schedules, which determine the maximum allowable reimbursement rates for medical services provided to injured workers. These updates are typically based on various factors, such as changes in the cost of healthcare services, and aim to ensure that injured workers have access to reasonable and necessary medical treatment.
- Return-to-Work Supplement Program (RTWSP): The Return-to-Work Supplement Program (RTWSP) provides additional benefits to eligible workers who experience a decrease in earnings due to a work-related injury or illness. Recent updates to the RTWSP include an increase in the maximum amount of the supplement from $6,000 to $10,000 for injuries occurring on or after January 1, 2020. This increase is intended to provide additional support to injured workers as they transition back to work.
- Medical-Legal Fee Schedule: California has implemented changes to the Medical-Legal Fee Schedule, which governs the fees that can be charged for medical-legal evaluations and reports in workers’ compensation cases. These changes include updates to the maximum allowable fees for medical-legal services, as well as requirements for electronic billing and submission of medical-legal reports.
- Independent Bill Review (IBR): Independent Bill Review (IBR) is a process used to resolve disputes related to medical billing in workers’ compensation cases. Recent updates to IBR include changes to the timelines for submitting and processing IBR applications, as well as requirements for electronic submission of bills and related documents.
- Telehealth and Telemedicine: California has expanded the use of telehealth and telemedicine in workers’ compensation cases, particularly in light of the COVID-19 pandemic. These updates allow for remote provision of medical treatment and evaluation through telehealth and telemedicine technologies, providing injured workers with increased access to healthcare services, particularly in rural or underserved areas.
- Anti-Fraud Measures: California has implemented various anti-fraud measures aimed at reducing fraudulent activities in the workers’ compensation system. These measures include increased penalties for fraudulent activities, enhanced enforcement efforts, and increased collaboration between government agencies and law enforcement to investigate and prosecute workers’ compensation fraud.
It’s important to note that workers’ compensation laws and regulations are subject to change, and it’s recommended to consult with a qualified Workers Compensation lawyer or the appropriate government agencies for the most up-to-date information on California workers’ compensation law.