ANOTHER “NEW WORLD” OF WORKERS’ COMPENSATION

Senate Bill 863 [SB 863] was rushed through the legislative process in about 3 days during the end of August, 2012. In September, Governor Jerry Brown approved it. This new body of legislation will have impact (some negative, some positive) on all pending cases that have not been resolved by December 31, 2012. The new laws will likewise impact new cases with Date of Injury on or after January 1, 2013.

The Good News

Overall, the Permanent Disability for Date of Injury on or after 1-1-13 will increase. Looking at all possible effect upon the range of all cases, the average increase will be around 30%.

The So-So News

As of 1-1-13 (for cases with that date of injury or later) all disputes regarding Medical Treatment will be submitted to “independent” doctors to resolve promptly (i.e., within 30 days from date they receive dispute). This process will be called Independent Medical Review (IMR). We will not learn the identity of the doctor reviewing a particular dispute. We will have to wait and see exactly how “promptly” and FAIRLY these doctors resolve medical treatment issues. It could be a good thing…getting issues resolved much quicker than the current Panel QME process (which frequently takes 6 months or longer to be resolved). The IMR process will also apply to all cases as of 7-1-13.

The Bad News

Most claims for psychiatric, sleep or sexual-dysfunction disorders that source from a physical injury (i.e., your back is hurt, you have chronic pain, and you develop depression with the chronic pain), can no longer be compensated in Permanent Disability benefits. You can be treated for these symptoms—provided, however, that the IMR doctor (see above) approves it when the carrier refuses to provide the treatment.

Regulations implementing these new laws are currently in process. They are likely to tweak and clarify some of the new laws.

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NOTICE: Making a false or fraudulent Workers Compensation claim is a felony subject to up to 5 years in prison or a fine of up to $50,000 or double the value of the fraud, whichever is greater, or by both imprisonment and fine.