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Calif. sees amendments in workers' compensation

New laws to be aware of went into effect this year

Cases and claims dealing with workers' compensation got some major overhauls with Senate Bill 863, which took effect Jan. 1.

SB 863 points out five major areas that were amended from previous worker compensation laws.

The first change is in permanent disability. Both the minimum and maximum weekly benefit amounts have been raised. The increases are to be phased in over a two-year period, with the maximum weekly permanent disability rate being elevated to $290.

Also, permanent disability add-ons for psychiatric injuries resulting from physical injuries are limited to “catastrophic” injuries and cases in which the injured worker was either the victim of a violent crime, or witnessed a violent crime.

"This is unfortunate because you could have cases where you injure your back and have severe depression because you can’t work or do some of the active things you were used to," said Carl Kreibich, attorney at the personal injury firm Bender & Gritz.

Changes to supplemental job displacement vouchers have also taken place.

Injured workers may now be offered supplemental job displacement vouchers that can be used to pay for job retraining as a fixed amount of $6,000.

Previously, the voucher amount was a sliding scale ranging from $4,000 to $10,000. The voucher is to be offered when the injured worker reaches permanent and stationary status, and the treating doctor reports on work abilities and limitations resulting from the injury.

SB 863 also establishes a $120 million per year “Return-to-Work Fund,” to be established and administered by the Department of Industrial Relations.

Payments from the fund will be available to injured workers whose permanent disability ratings are disproportionately low in comparison to their wage loss.

Kreibich said another significant change to worker compensation cases because of SB 863 is how medical treatment disputes will be resolved.

An independent medical review will now be used to decide disputes regarding medical treatment in workers’ compensation cases for all injuries.

Previously, the process required eight steps to complete, and it would typically take from nine to 12 months to resolve a dispute over the treatment needed for an injury.

Kreibich asked: “What I question with this law change is why under the independent medical review is the doctor’s name anonymous on the paperwork of the diagnosis?”

The independent medical review can only be requested by an injured worker following a denial, modification or delay of a treatment request through the utilization review process.

Employers and insurance carriers cannot request review of treatment authorizations, and an injured worker can be assisted by an attorney or by his or her treating physician in the medical review process.

SB 863 also tackles issues dealing with Medical Provider Networks. The requirement that 25 percent of doctors within the network must practice in areas other than occupational medicine has been removed.

Also, doctors are required to confirm their participation in a network.

Networks will also be required to provide medical access assistants who will be available to injured workers to assist them in locating appropriate doctors within the network.

Senate Bill 863 was the product of months of negotiations between representatives of labor unions and employers who historically came together to work on a comprehensive workers’ compensation reform package.

There were two guiding principles when SB 863 was negotiated.

The first was that permanent disability benefits paid to injured workers to compensate them for the lasting effects of work-related injuries were too low and had to be increased.

The second was that the costs associated with providing medical treatment and benefits to injured workers and administering workers’ compensation claims had begun to rise significantly.

Labor and management agreed that in order for benefits to be increased, costs would have to be decreased where possible. They also agreed that where possible, the workers’ compensation process should be made more efficient.

Implementations of the changes brought about by SB 863 were overseen by teams from both the California Department of Industrial Relations and the Division of Workers’ Compensation.

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