Effective January 1, 2013, new provisions of California’s workers’ compensation insurance system reform bill (SB 863) were implemented by the Department of Industrial Relations (DOI) and Division of Workers Compensation (DWC). The new provisions, approved on an interim basis, are effective for 180 days while DWC initiates formal rulemaking procedures to adopt permanent regulations. Details of the newly implement regulations include:

Utilization review, independent medical review
For injuries on or after Jan. 1, 2013, and effective July 1, 2013 for all dates of injury, medical treatment disputes will be resolved through an independent medical review (IMR) process. Injured workers who receive denials, delays or modifications to a physician’s request for medical treatment because the treatment is deemed not medically necessary by the workers’ comp carrier can request an independent review of that decision through the IMR process.

Independent bill review
For dates of service on or after January 1, 2013, billing disputes involving payment for medical services may be submitted through a process known as independent bill review (IBR). Medical providers disagreeing with the amount paid by a claims administrator and seeking an independent determination on payment may submit a request for IBR providing details and/or supporting documentation along with the non-refundable IBR fee of $335.

Electronic document filing and lien filing fee
The new law allows certain claims for payment for services or benefits provided to or on behalf of injured workers to be filed as a lien against an the employee’s claim for workers’compensation benefits. Any lien for reasonable medical expenses incurred by or on behalf of the injured employee and filed on or after January 1, 2013, is now subject to a lien filing fee of $150. For liens filed before January 1, 2013, there will also be a $100 activation fee, which must be paid prior to January 1, 2014, or the lien will be subject to dismissal by operation of law.

CMA is actively participating in stakeholder meetings and will continue to monitor the regulations closely. Updates will be published as they are available.