According to a report from the Insurance Journal, the total amount of workers’ compensation losses paid has gradually increased over the past decade. Notably, this comes after the passing of Senate Bill 863 (SB 863), which reformed the handling of medical treatment disputes in workers’ compensation claims in California. SB 863 was signed into law in September of 2012. In this article, our Fresno workers’ compensation defense law firm provides an overview of the analysis.

The History: SB 863 Reformed Workers’ Compensation Medical Treatment Disputes in California

In 2012, the passage and signing of SB 863 marked a significant transformation of workers’ compensation law in California. A comprehensive piece of legislation, SB 893 was touted by its proponents as a bill that could better balance the interests of employers and injured workers. It promised to increase benefits for injured workers while concurrently creating systems and processes to improve efficiency and cut costs within the system.

How did the law seek to achieve its goals? A core part of the reform was the streamlining of medical treatment disputes. SB 863 introduced Independent Medical Review (IMR). The IMR is conducted by independent medical professionals who are not involved in the injured worker’s care. These reviewers evaluate the medical necessity of the disputed treatment by examining the worker’s medical records, the treating doctor’s recommendations, and relevant medical guidelines.

The Findings: Losses Paid Out Initially Dropped, Then Gradually Increased

A new study by the California Workers’ Compensation Institute (CWCI) reveals that average paid losses on California workers’ compensation lost-time claims fell immediately after the legislative reforms of SB 863 a decade ago. That being said, the decline in costs did not last. Despite initial declines post-reform, average paid losses on claims within 60 months of injury are now above their post-reform lows. The study, which analyzed nearly 570,000 indemnity claims over a 10-year period, noted average total losses fell after the 2012 reforms but began to rise again starting in 2015 and continuing through 2020.

The Scope of Medical Treatment is Often Dispute in Workers’ Compensation Claims

The scope of medical treatment is a frequent point of contention in California workers’ compensation claims. When an employee sustains a work-related injury, they are generally entitled to medical treatment necessary to relieve or cure from the effects of the injury. However, an employee does not simply get to decide what treatment they will receive through workers’ compensation. Indeed, disputes can arise regarding the necessity, extent, and type of medical treatment. Employers and their insurance companies may challenge the need for certain treatments, procedures, or medications, leading to delays or denials in providing medical benefits.

Contact Our Fresno, CA Workers’ Compensation Defense Lawyer Today

At Yrulegui & Roberts, we are a law firm specializing in workers’ compensation defense. Our attorneys represent employers, claims administrators, and insurance companies. Contact us today to arrange your strictly confidential initial appointment. Our firm provides workers’ compensation defense services in Fresno, Fresno County, and WCAB locations all across the surrounding region.