Labor Code Section 4656 prohibits aggregate temporary disability payments for a single injury occurring on or after January 1, 2008, causing TD from extending for more than 104 compensable weeks within a period of 5 years from the date of injury, except if an employee suffers from certain injuries or conditions.
Assembly Bill 1213 introduced by Assembly member Liz Ortega (D-San Leandro) provides that if a utilization review (UR) denial of treatment recommended by a treating physician for an injured worker is overturned by IMR, any TD benefits paid or owing to the injured worker from the date of the UR denial until the date of the IMR decision shall not be used in calculating aggregate TD for which the injured worker is eligible.
The California Applicants’ Attorneys Association, the sponsor of this bill, writes in support arguing “It is wrong for TD benefits for so many injured workers to end when necessary treatment was erroneously or unreasonably denied, and the denial delayed the injured worker’s recovery and return to work.”
In opposition, California Coalition on Workers’ Comp and other employer organizations, argued the bill is not needed because “The actual delay in the system related to care comes from the overuse of IMR by a small number of attorneys and physicians trying to push care that is conflicting with the state-established guidelines for determining medical necessity.”
AB 1213 was passed by the California Legislature. However, on October 8, Governor Newsom vetoed the proposed law.
In his veto message he said “While I understand the goal of the author and sponsor, there is a lack of data to support such a change. Under the existing workers’ compensation system, employers are required to establish a UR process to evaluate the necessity and appropriateness of requested medical treatments. This process is in place to ensure that employees receive the appropriate evidence-based medical care.”
“Realigning incentives is an important policy tool to deliver on our shared goal of returning injured workers back to work. Such realignment should be done cautiously to avoid further friction in the system that frustrates the objective of providing timely treatment, prompt payment of benefits and returning injured workers back to work. Unfortunately, this bill does not strike the right balance.”
“For these reasons, I cannot sign this bill.”