California Labor Codes 4600.3 464

(a) (1) Notwithstanding Section 4600, when a self-insured employer, group of self-insured employers, or the insurer of an employer contracts with at least two health care organizations certified pursuant to Section 4600.5 for health care services required by this article to be provided to injured employees, those employees who are subject to the contract shall receive medical services in the manner prescribed in the contract, providing that the employee may choose to be treated by a personal physician, personal chiropractor, or personal acupuncturist that he or she has designated prior to the injury, in which case the employee shall not be treated by the health care organization. Every employee shall be given an affirmative choice at the time of employment and at least annually thereafter to designate or change the designation of a health care organization or a personal physician, personal chiropractor, or personal acupuncturist. The choice shall be memorialized in writing and maintained in the employee's personnel records. The employee who has designated a personal physician, personal chiropractor, or personal acupuncturist may change their designated caregiver at any time prior to the injury. Any employee who fails to choose between health care organizations or to designate a personal physician, personal chiropractor, or personal acupuncturist shall be treated by the health care organization selected by the employer. (2) Each contract described in paragraph (1) shall comply with the certification standards provided in Section 4600.5, and shall provide all medical, surgical, chiropractic, acupuncture, and hospital treatment, including nursing, medicines, medical and surgical supplies, crutches, and apparatus, including artificial members, that is reasonably required to cure or relieve the effects of the injury, as required by this division, without any payment by the employee of deductibles, copayments, or any share of the premium. However, an employee may receive immediate emergency medical treatment that is compensable from a medical service or health care provider who is not a member of the health care organization. (3) The employee shall be allowed to choose from at least two health care organizations, of which at least one must be compensated on a fee-for-service basis. If one or more of the health care organizations offered by the employer is the workers' compensation insurer that covers the employee or is an entity that controls or is controlled by that insurer, as defined by Section 1215 of the Insurance Code, the employee shall be allowed to choose from at least one additional health care organization, that is not the workers' compensation insurer that covers the employee, or entities that control or are controlled by that insurer, of which at least one must�be � compensated on a fee-for-service basis. � (4) � Insurers of employers, a group of self-insured employers, or�self-insured � employers who contract with a health care organization�for � medical services shall give notice to employees of eligible�medical � service providers and any other information regarding the�contract � and manner of receiving medical services as the�administrative � director may prescribe. Employees shall be duly�notified � that if they choose to receive care from the health care�organization � they must receive treatment for all occupational�injuries � and illnesses as prescribed by this section.

(b) � Notwithstanding subdivision (a), no employer which is required�to � bargain with an exclusive or certified bargaining agent which�represents � employees of the employer in accordance with state or�federal � employer-employee relations law shall contract with a health�care � organization for purposes of Section 4600.5 with regard to�employees � whom the bargaining agent is recognized or certified to�represent � for collective bargaining purposes pursuant to state or�federal � employer-employee relations law unless authorized to do so by�mutual � agreement between the bargaining agent and the employer. If�the � collective bargaining agreement is subject to the National Labor�Relations � Act, the employer may contract with a health care�organization � for purposes of Section 4600.5 at any time when the�employer � and bargaining agent have bargained to impasse to the extent�required � by federal law.

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(c) (1) When an employee is not receiving or is not eligible to�receive � health care coverage for nonoccupational injuries or�illnesses � provided by the employer, if 90 days from the date the�injury � is reported the employee who has been receiving treatment from�a � health care organization or his or her physician, chiropractor,�acupuncturist, � or other agent notifies his or her employer in writing�that � he or she desires to stop treatment by the health care�organization, � he or she shall have the right to be treated by a�physician, � chiropractor, or acupuncturist or at a facility of his or�her � own choosing within a reasonable geographic area. � (2) � When an employee is receiving or is eligible to receive health�care � coverage for nonoccupational injuries or illnesses provided by�the � employer, and has agreed to receive care for occupational�injuries � and illnesses from a health care organization provided by�the � employer, the employee may be treated for occupational injuries�and � diseases by a physician, chiropractor, or acupuncturist of his or�her � own choice or at a facility of his or her own choice within a�reasonable � geographic area if the employee or his or her physician,�chiropractor, � acupuncturist, or other agent notifies his or her�employer � in writing only after 180 days from the date the injury was�reported, � or upon the date of contract renewal or open enrollment of�the � health care organization, whichever occurs first, but in no case�until � 90 days from the date the injury was reported. � (3) � If the employee is receiving or is eligible to receive health�care � coverage for nonoccupational injuries or illnesses provided by�the � employer, and his or her physician, chiropractor, or�acupuncturist � for nonoccupational illnesses or injuries is�participating � in at least one of the health care organizations�offered � to the employee, and he or she has chosen treatment by one of�these � health care organizations for occupational injuries or�illnesses, � the employee may be treated by a physician, chiropractor,�or � acupuncturist of his or her own choice or at a facility of his or�her � own choice within a reasonable geographic area if the employee or�his � or her physician, chiropractor, acupuncturist, or other agent�notifies � his or her employer in writing only after 365 days from the�date � the injury was reported, or upon the date of contract renewal or�open � enrollment, whichever occurs first, but in no case until 90�days � from the date the injury was reported. � (4) � For purposes of this subdivision, an employer shall be deemed�to � provide health care coverage for nonoccupational injuries and�illnesses � if the employer pays more than one-half the costs of the�coverage, � or if the plan is established pursuant to collective�bargaining.

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(d) � An employee and employer may agree to other forms of therapy�pursuant � to Section 3209.7.

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(e) � An employee enrolled in a health care organization shall have�the � right to no less than one change of physician on request, and�shall � be given a choice of physicians affiliated with the health care�organization. � The health care organization shall provide the�employee � a choice of participating physicians within five days of�receiving � a request. In addition, the employee shall have the right�to � a second opinion from a participating physician on a matter�pertaining � to diagnosis from a participating physician.

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(f) � Nothing in this section or Section 4600.5 shall be construed�to � prohibit a self-insured employer, a group of self-insured�employers, � or insurer from engaging in any activities permitted by�Section � 4600.

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(g) � Notwithstanding subdivision (c), in the event that the�employer, � group of employers, or the employer's workers' compensation�insurer � no longer contracts with the health care organization that�has � been treating an injured employee, the employee may continue�treatment � provided or arranged by the health care organization. If�the � employee does not choose to continue treatment by the health care�organization, � the employer may control the employee's treatment for�30 � days from the date the injury was reported. After that period,�the � employee may be treated by a physician of his or her own choice�or � at a facility of his or her own choice within a reasonable�geographic � area.

� 4600.4. �

(a) A workers' compensation insurer, third-party�administrator, � or other entity that requires, or pursuant to�regulation � requires, a treating physician to obtain either�utilization � review or prior authorization in order to diagnose or�treat � injuries or diseases compensable under this article, shall�ensure � the availability of those services from 9 a.m. to 5:30 p.m.�Pacific � coast time of each normal business day.

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(b) For purposes of this section 'normal business day' means a�business � day as defined in Section 9 of the Civil Code.