BILL NUMBER: SB 457	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  AUGUST 26, 2011
	AMENDED IN ASSEMBLY  JUNE 28, 2011
	AMENDED IN SENATE  MAY 4, 2011

INTRODUCED BY   Senator Calderon

                        FEBRUARY 16, 2011

   An act to amend Section 4903.1 of the Labor Code, relating to
workers' compensation.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 457, as amended, Calderon. Workers' compensation: liens.
   Existing law establishes a workers' compensation system,
administered by the Administrative Director of the Division of
Workers' Compensation, to compensate an employee for injuries
sustained in the course of his or her employment. Existing law
authorizes a medical provider to file a lien claim with the Workers'
Compensation Appeals Board for certain expenses incurred by the
provider. Under existing law, the board is required to allow a lien
to the extent of benefits paid or services provided for reimbursement
for self-procured medical costs for the effects of an injury or
illness arising out of and in the course of employment.
   Existing law requires the administrative director, after public
hearings, to adopt and revise periodically an official medical fee
schedule that establishes reasonable maximum fees paid for medical
services, other than prescribed goods and services, in accordance
with specified requirements.
   This bill would require the board to determine, on the basis of
liens filed, reimbursement for benefits paid or services provided by
a  health care service plan, a group disability policy, a
hospital service contract, or a  self-insured employee
welfare benefit plan notwithstanding the official medical fee
schedule when an award is made for reimbursement for self-procured
medical costs for the effects of an injury or illness arising out of
and in the course of employment. This bill would also state that its
provisions  are not to be deemed as modifying  
do not modify  in any way specified rights or obligations.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 4903.1 of the Labor Code is amended to read:
   4903.1.  (a) The appeals board, arbitrator, or settlement
conference referee, before issuing an award or approval of any
compromise of claim, shall determine, on the basis of liens filed
with it pursuant to subdivision (b) or (c), whether any benefits have
been paid or services provided by a health care provider, a health
care service plan, a group disability policy, including a loss of
income policy, a self-insured employee welfare benefit plan, or a
hospital service contract, and its award or approval shall provide
for reimbursement for benefits paid or services provided under these
plans as follows:
   (1) When the referee issues an award finding that an injury or
illness arises out of and in the course of employment, but denies the
applicant reimbursement for self-procured medical costs solely
because of lack of notice to the applicant's employer of his need for
hospital, surgical, or medical care, the appeals board shall
nevertheless award a lien against the employee's recovery, to the
extent of benefits paid or services provided, for the effects of the
industrial injury or illness, by a health care provider, a health
care service plan, a group disability policy, a self-insured employee
welfare benefit plan, or a hospital service contract.
   (2) When the referee issues an award finding that an injury or
illness arises out of and in the course of employment, and makes an
award for reimbursement for self-procured medical costs, the appeals
board shall allow a lien, to the extent of benefits paid or services
provided, for the effects of the industrial injury or illness, by a
health care provider, a health care service plan, a group disability
policy, a self-insured employee welfare benefit plan, or a hospital
service contract. For purposes of this paragraph, benefits paid or
services provided by  a health care service plan, a group
disability policy, a hospital service contract, or a self-insured
  self-insured  employee welfare benefit plan shall
be determined notwithstanding the official medical fee schedule
adopted pursuant to Section 5307.1.
   (3) When the referee issues an award finding that an injury or
illness arises out of and in the course of employment and makes an
award for temporary disability indemnity, the appeals board shall
allow a lien as living expense under Section 4903, for benefits paid
by a group disability policy providing loss of time benefits. Such
lien shall be allowed to the extent that benefits have been paid for
the same day or days for which temporary disability indemnity is
awarded and shall not exceed the award for temporary disability
indemnity. No lien shall be allowed hereunder unless the group
disability policy provides for reduction, exclusion, or coordination
of loss of time benefits on account of workers' compensation
benefits.
   (4) When the parties propose that the case be disposed of by way
of a compromise and release agreement, in the event the lien
claimant, other than a health care provider, does not agree to the
amount allocated to it, then the referee shall determine the
potential recovery and reduce the amount of the lien in the ratio of
the applicant's recovery to the potential recovery in full
satisfaction of its lien claim.
   (b) When a compromise of claim or an award is submitted to the
appeals board, arbitrator, or settlement conference referee for
approval, the parties shall file with the appeals board, arbitrator,
or settlement conference referee any liens served on the parties.
   (c) Any lien claimant under Section 4903 or this section shall
file its lien with the appeals board in writing upon a form approved
by the appeals board. The lien shall be accompanied by a full
statement or itemized voucher supporting the lien and justifying the
right to reimbursement and proof of service upon the injured worker,
or if deceased, upon the worker's dependents, the employer, the
insurer, and the respective attorneys or other agents of record.
   (d) The appeals board shall file liens required by subdivision (c)
immediately upon receipt. Numbers shall be assigned pursuant to
subdivision (c) of Section 5500.
   (e) The changes made to this section by Senate Bill 457 of the
2011-12 Regular Session do not modify in any way the rights or
obligations of the following:
   (1) Any health care provider to file and prosecute a lien pursuant
to subdivision (b) of Section 4903.
   (2) A payor to conduct utilization review pursuant to Section
4610.
   (3) Any party in complying with the requirements under Section
4903.