Proposed Workers’ Compensation Regulations Would Allow Out-of-State Physicians To Provide Second Opinions
The Division of Workers' Compensation has proposed regulations that would allow insurers to contract with out-of-state physicians not licensed to practice medicine in California to offer a second opinion on treatment plans for workers' compensation claimants, the Los Angeles Times reports. Under a provision of the 2004 legislation that overhauled the state workers' compensation insurance system, insurers can ask outside medical experts for an added opinion if they disagree with a treatment prescribed for a workers' compensation claimant.
DWC Director Andrea Hoch said the proposal is consistent with the review process used by HMOs for non-work-related care. Hoch said, "[T]he fact that [the reviewing doctors] are not licensed in California does not mean they are not capable of reviewing treatment requests and applying guidelines that are national."
However, the Medical Board of California said the proposed regulations would violate state law because they would in effect permit physicians not licensed in California to practice medicine in the state.
In addition, the California Medical Association said that insurers already are hiring out-of-state physicians to perform the task, adding that state law permits only physicians licensed by California to make treatment decisions.
CMA CEO Jack Lewin said, "We can't talk to [reviewing doctors] when they are far away; we have no way of evaluating whether they are competent or not, and we can't complain" to state regulators.
Worker advocates said that the practice keeps workers' compensation claimants from receiving medical care, but insurers say claims costs could increase substantially and make higher premiums for employers more likely if all review work is done by California physicians (Lifsher, Los Angeles Times, 9/19).