Workers' Comp Reform

Senate Bill 863

One of Governor Brown’s landmark reforms, Senate Bill 863 passed on August 1, 2012, and was signed into law on Sept. 18, 2012. The bill makes wide-ranging changes to California’s workers’ compensation system, including increased benefits to injured workers and cost-saving efficiencies. The bill took effect on Jan. 1, 2013, although some of its provisions take effect at a later date.

The Division of Workers’ Compensation offers the following tools to assist you in analyzing and evaluating the impact of SB 863.

Medical treatment and medical-legal billing disputes are resolved through an independent bill review (IBR) process. A medical provider who disagrees with the amount paid by a claims administrator on a properly documented bill may apply for IBR. IBR applies to any medical service bill where the date of service is on or after Jan. 1, 2013 and where the fee is determined by a fee schedule established by the DWC.

California's workers' compensation system uses a process called independent medical review (IMR) to resolve disputes about the medical treatment of injured employees. As of July 1, 2013, medical treatment disputes for all dates of injury will be resolved by physicians through an efficient process known as IMR, rather than through the often cumbersome and costly court system.

A request for medical treatment in the workers' compensations system must go through a "utilization review" process to confirm that it is medically necessary before it is approved. If utilization review denies, delays or modifies a treating physician's request for medical treatment because the treatment is not medically necessary, the injured employee can ask for a review of that decision through IMR.

California's workers' compensation 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.

Qualified medical evaluators (QMEs) are qualified physicians who are certified by the Division of Workers' Compensation - Medical Unit to examine injured workers to evaluate disability and write medical-legal reports. The reports are used to determine an injured worker's eligibility for workers' compensation benefits. QMEs include medical doctors, doctors of osteopathy, doctors of chiropractic, dentists, optometrists, podiatrists, psychologists and acupuncturists.

If an injured worker does not proficiently speak or understand the English language, interpreter services must be provided at depositions, appeals board hearings, medical-legal examinations, and medical treatment appointments. Learn about different standards for interpreters and how to get certified for each of them.

July 2017