According to a report from the California Globe, a recently proposed state law (California Senate Bill 636 (SB 636)) would require the use of a California-licensed physician for a utilization review in a workers’ compensation claim. Within this article, our Bakersfield workers’ compensation defense attorney highlights the key things employers, claims administrators, and insurance companies should know about the proposed bill.

Background: Utilization Reviews in California Workers’ Compensation Claims

Utilization reviews (UR) are a key component of the California workers’ compensation system. In effect, these reviews are conducted in order to ensure that medical treatment provided to injured workers is appropriate and necessary. At its core, a UR is intended to prevent unnecessary medical treatment and expenses while also ensuring that injured workers receive the care they need to recover and return to work.

In California, the Department of Industrial Relations (DIR) oversees the UR process, and it is required by law in all workers’ compensation cases. From the perspective of workers’ compensation defense and controlling costs, it is imperative that employers and insurance companies know how to effectively navigate the utilization review process.

Utilization Reviews have Been a Source of Conflict in California

It is worth noting that URs have long been a source of conflict and controversy in California. Some of the critics of the existing system argue that utilization reviews too often lead to delays in care and denials of treatment. On the other hand, proponents of URs counter that they are essential to controlling costs and ensuring quality care.

Proposed State Reform Would Require Employers/Insurers to Use Licensed Physicians

In February 2023, California State Senator Dave Cortese (Democrat, San Jose) introduced Senate Bill 636 (SB 636) into the legislature in Sacramento. If signed into law, SB 636 would put additional restrictions in place for how employers, claims administrators, and insurance companies could use the utilization review process. Most notably, the reform would require employers and insurers to use licensed physicians for utilization reviews and medical treatment decisions.

Of course, California Senate Bill 636 is not yet law in the state. The proposed bill has a long way to go before it becomes law. It would need to pass both branches of the California legislature and get a signature from Governor Gavin Newsom. The proposed legislation is certain to face some significant pushback, as it could drive up costs in the workers’ compensation system. Our workers’ compensation defense law firm will keep a close watch on this bill and all other legal and legislative developments.

Get Professional Guidance and Support From a Bakersfield Workers’ Compensation Defense Lawyer

At Yrulegui & Roberts, our Bakersfield workers’ compensation defense attorneys are experienced, principled, and solutions-driven advocates for our clients. If you have any questions about utilization reviews (URs), we are here as a legal resource. Call us now or contact us online to set up your completely confidential, no-obligation initial case assessment. We provide workers’ compensation defense representation in Bakersfield and throughout the wider area of California.