AB 749 and Physicians

Sunday, November 24, 2002 | 0

The following is a brief description of the various changes to the Labor Code (and in one instance, Insurance Code) that were made law by AB 749, effective 1/1/03, that affect physicians. workcompcentral will be reviewing these provisions in more detailed analysis in later articles.

Insurance Code 11784 - permits the State Compensation Insurance Fund to contract with physician, surgeons and hospitals for medical and surgical treatment, care and nursing of injured workers entitled to benefits from the Fund.

127.6 is added to the Labor Code directing the administrative director to conduct a study on medical care including physician utilization. The study shall start by 7/1/03.

139.48 is added to the Labor Code requiring the administrative director to establish a Return to Work Program where employers can get reimbursements for wages paid to injured workers that return to modified or alternative work compatible with the treating physician's imposed work restrictions.

3822 is added to the Labor Code requiring the administrative director to annually provide a fraud warning to everyone that does anything in work comp, including physicians and attorneys.

4061/4062 permit the medical evaluator preparing a medical legal opinion to obtain opinions from other physicians "who have treated the employee for the injury whose expertise is necessary to provide a complete and accurate evaluation." Further opinions of the treating physician, QME or AME may be used to make determinations of PD, VR and all other ancillary issues.

4062.9 is amended to reflect that the opinions of pre-designated treating physicians carry a rebuttable presumption of correctness for injuries post 1/1/03. Treating physicians will also be getting educational materials developed by the administrative director post 1/1/04.

4064 is amended to provide that injured workers who obtain representation after a 4061 or 4062 evaluation can have evaluations and reports as though he were represented from the start.

4600.1 requires all prescriptions to be generic unless the treating physician prescribes otherwise.

4600.3 removes the right of the employer to force HCO treatment where the employee designates a personal treating physician, chiropractor or acupuncturist prior injury. (the way I read this provision - an employee could choose an acupuncturist, e.g. but doesn't need to be treated by that acupuncturist - can take any physician - and regardless the employer looses their rights). 90 days from injury, if employee not otherwise covered for health benefits, then can decline HCO care in writing and choose his or her own personal treating physician. If the employee is being treated by an HCO then he has the right to change at least once to another physician in that HCO. In addition the employee has the right to a second opinion from a "participating physician". If the HCO contract ends, then the employee can choose his own physician for treatment after 30 days from the injury.

Physician's reporting duties under 4628 is amended, with additional penalties that may be imposed for knowing failure to comply, in addition to inadmissibility of the report and irradication of liability for report charges.

4644 is amended to require the Rehabilitation Unit to consider "any treating physicians reports."

5307.21 is added requiring the administrative director to establish an outpatient surgical fee schedule which shall not include the fee of any physician providing services in connection with the surgery.

5401 is amended to redefine first aid as any "one time treatment" regardless of whether provided by a physician or any other "registered professional personnel."