CA Dreaming of a Streamlined Workers' Comp Procedure

San Bernardino, CA (WorkersCompensation.com) - On Dec. 2, 2015, married couple Syed Rizwan Farook and Tashfeen Malik opened fire at a staff meeting and luncheon taking place at the Inland Regional Center in San Bernardino, CA. Farook, a health inspector with the San Bernardino Department of Public Health, and his companion killed 14 coworkers and injured 22 others before fleeing the scene in an SUV and later being killed in a shootout with law enforcement. For the unfortunate workers who were injured that day, getting full redress through the state’s workers’ compensation system has been difficult. 

The California Department of Industrial Relations (CDIR) oversees the state’s workers’ compensation system. The problem those injured in the San Bernardino shooting face is that what they and their doctors deem to be medically necessary often differs from what the CDIR believes to be medically necessary. Although certainly not an uncommon conflict in workers’ compensation law, the procedure for resolving these conflicts can take several months.

In response to this problem, California Assemblymember Eloise Gomez Reyes, who represents the district where San Bernardino is located, introduced Assembly Bill No. 44. According to the Legislative Counsel’s Digest, which spells out the purpose of the bill, the current “law requires every employer to establish a utilization review process, and defines ‘utilization review’ as utilization review or utilization management functions that prospectively, retrospectively, or concurrently review and approve, modify, or deny, based in whole or in part on medical necessity to cure and relieve, treatment recommendations by physicians, prior to, retrospectively, or concurrent with providing medical treatment services.” In layman’s terms this means that every medical procedure stemming from a workplace accident must be reviewed before it can be approved. Disputes over the decisions from the “utilization review” go to an independent medical review.

The Bill Digest continues as follows:

This bill would exempt medical treatment for employees or first responders who sustain physical or psychological injury as a result of an act of terrorism or violence in the workplace from the utilization review process and the independent medical review process, and would provide for an expedited proceeding before the Workers’ Compensation Appeals Board to resolve disputes regarding treatment. The bill would also apply retroactively to the employees and first responders injured in the San Bernardino terrorist attack of December 2, 2015, and any other employees or first responders injured by an act of terrorism or violence in the workplace that occurs prior to January 1, 2018.

In short, anyone injured from workplace violence or terrorism will no longer have to go through the “utilization review” prior to having medical treatment approved. Instead, the proposed bill requires “[d]isputes regarding treatment under this section shall be decided in an expedited proceeding, within 30 days after the declaration of readiness is filed, with a determination as to the rights of the parties made and served by the Workers’ Compensation Appeals Board.” 

As of January of this year, the bill had been referred to the Committee on Insurance, which is the first step. Once it gets out of committee, it can go to a full vote of the state assembly and then to the state senate. Given the politically charged nature of the revisions, it seems likely this bill, or something fairly close to it, will eventually be passed.

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