California: First regulations from S.B. 863 released
"We are on track to implement the wide-ranging reform which was the result of extensive input by workers and employers," said Christine Baker, DIR director. "These reforms are engineered to reduce unnecessary costs while redirecting some of the savings to increase benefits for disabled workers."
S.B. 863 was passed last year with portions being phased in over a period of time. In addition to an increase in permanent disability benefits, the legislation creates an independent medical panel to review injuries and addresses the state's lien process and billing disputes.
The new regulations include:
- Independent medical review. Disputes over medical treatment will be resolved by physicians via an independent medical review process. Injured workers whose treatment has been denied, delayed, or modified may request an IMR review, designed to be "expeditious and based upon evidence-based standards," the DIR said. The new regs stipulate that IMR is the sole process for resolving disputes over ongoing medical treatment issues. They also limit the number of offices from which a qualified medical evaluator may conduct evaluations, streamline the application process for chiropractors, allow for factual corrections of a comprehensive medical-legal report from a QME panel, and amend several forms.
- Independent bill review. Billing disputes over medical service will be resolved through a nonjudicial process of independent bill review, which will apply to any medical service bill where the fee is determined by the schedule adopted by the Division of Workers' Compensation. Physicians who disagree with the amount paid after a second review may request an IBR.
- Electronic document filing/lien filing fee. Any lien for reasonable medical expenses is subject to a filing fee of $150 with the exception of disputes subject to IMR or IBR. A $100 activation fee will be applied to liens filed before Jan. 1 and must be paid prior to Jan. 1, 2014, or the lien will be subject to dismissal.
Additional regulations address self-insurance and annual actuarial reports, interpreter services, supplemental job displacement benefits, and hospital outpatient departments and ambulatory surgical centers' fee schedules.
Read more at the WorkersComp Forum homepage.
January 28, 2013
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