Bill Seeks To Protect Pre-Approved Injured Workers’ Treatment Plans
On Wednesday, the California Senate Labor and Industrial Relations Committee approved a bill (SB 563) that aims to bar insurers from using treatment requests to deny pre-approved care for injured workers, ProPublica reports (Grabell, ProPublica, 4/29).
In March, the committee started investigating a 2012 law (SB 863) that overhauled the state's workers' compensation program to determine whether it has met expectations.
The law -- by Sen. Kevin de León (D-Los Angeles) and former Assembly member Jose Solorio (D-Anaheim) -- changed the formula used to calculate benefits for injured workers, increasing their compensation by an average of 29%.
It also eliminated benefits for certain health conditions that often are subject to lawsuits, such as psychiatric problems, sexual dysfunction and sleep loss.
The law applied retroactively, meaning requests for medical treatment are subject to review by insurance company physicians and more stringent guidelines.
Some stakeholders have said that the provision allows insurers to use minor treatment requests as a vehicle to revise previously approved care plans (California Healthline, 4/1).
Details of SB 563
SB 563, by state Sen. Richard Pan (D-Sacramento), seeks to address concerns about whether the 2012 workers' compensation law is being used to cut expensive but necessary care for injured workers.
Specifically, the bill would bar insurers from reviewing pre-approved treatment plans, except for cases when a worker's condition has changed or the current care is determined to be unsafe. Employers and insurers would be able to ask a physician to review cases if they have reasons to believe the current treatment is no longer appropriate.
However, they would be prohibited from ending such care until:
- An independent review is completed; and
- An alternative treatment plan is created.
The bill is sponsored by the California Medical Association.
Comments About Bill
Pan said the bill would "ensur[e] that these injured workers cannot be abruptly and harmfully cut off from care."
However, the California Chamber of Commerce has opposed the bill, calling it a potential "job killer." The group also said the bill could:
- Increase costs to employers;
- Reverse benefits of the 2012 law; and
- Result in inappropriate care.
Meanwhile, Jason Schmelzer of the California Coalition on Workers' Compensation said the issue should be studied more "so the injured worker receives treatment quickly, but is still protected from unnecessary and potentially harmful treatment" (ProPublica, 4/29).
Study Finds That Workers' Comp Law Appears To Reduce Costs
In related news, the 2012 workers' compensation reform law appears to have met expectations in reducing medical costs, according to a study by the Workers Compensation Research Institute, the Sacramento Bee's "Capitol Alert" reports.
For example, the study found that average payments per claim decreased by 5% in 2013, following years of increases. The study also found that the law helped moderate costs related to cash benefits and overhead of California's workers' compensation program.
Meanwhile, the study also applauded the Workers' Compensation Insurance Rating Bureau's recommended 5% reduction in the program's pure premium advisory rate (Walters, "Capitol Alert," Sacramento Bee, 4/30).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.