Workers' compensation reform - frequently asked questions - providers

Q. What is the effective date of Senate Bill 899?

A: Most sections of SB 899 became effective on April 19, 2004, the date it was signed into law by Governor Schwarzenneger. Some sections will become effective later on dates specified in the bill, and some sections are retroactive. Many provisions require that the Division of Workers' Compensation adopt implementing regulations.

Q. How do we find out about the status of new regulations as they are developed?

A: Information on new or revised regulations will be posted on the DWC web site at throughout the rulemaking process That page has a link to an online discussion forum on proposed new rules (the "DWC/WCAB Forum") as well as a link to a "proposed rulemaking" page, which provides the latest information about the status of proposed regulations needed to implement this bill. Also check the "announcements" page, where developments will be announced as they occur. DWC will continue to update these FAQs as more questions arise and more information is available.

Q: What does this bill mean to me?

A: This bill makes major changes to the state's workers' compensation system. It affects injured workers with an ongoing workers' compensation claim or case before the Workers' Compensation Appeals Board (WCAB), as well as all employees in general. It also affects employers, insurance carriers and medical providers. Some of the more common questions we have received to date from these groups are addressed below.

Q: What are these new "medical provider networks," and when do they go into effect?

A: Labor Code section 4600 provides that medical provider networks may be established by employers or insurers on or after Jan. 1, 2005. The network must meet certain standards. These include accessibility of care for common occupational injuries and illness, types of providers, continuity of care, medical decision making, and following treatment guidelines. The standards must also include a process for allowing employees a choice of provider in the network (after the first visit) and for getting second and third opinions. If an employer or insurer uses an approved medical provider network, covered employees would receive their medical care in this network, unless a predesignated physician is chosen prior to an injury. Medical provider networks must be approved by DWC before they can be used.

Q: How do we become approved as a medical provider network?

A: DWC will be developing regulations and conducting a rulemaking action over the next several months to govern the process for review and approval of medical provider networks following the provisions of Labor Code section 4616. Labor Code Section 4616.7 specifies that some organizations -- certified health care organizations, health care service plans, group disability insurers, and Taft-Hartley Health and Welfare funds -- may be deemed to be medical provider networks after the DWC administrative director determines that they meet certain additional capabilities.

Q: How do I become approved as an Independent Medical Review physician?

A: DWC will implement a process by which physicians who meet the requirements for IMR can apply and become approved to conduct independent medical review for certain disputed cases of employees receiving medical care in an approved medical provider network. DWC will adopt regulations to govern the application process over the next few months.

June 2004