Workers' compensation: utilization review.

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 requires every employer to establish a utilization review process, and defines "utilization review" as utilization review or utilization management functions that prospectively, retrospectively, or concurrently review and approve, modify, delay, or deny, based in whole or in part on medical necessity to cure and relieve, treatment recommendations by physicians, prior to, retrospectively, or concurrent with providing medical treatment services. This bill would prohibit employers that provide utilization review and entities that provide utilization review on behalf of an employer from requesting or accepting any compensation or other thing of value from any source that may create or creates a conflict with the duties of carrying out the utilization review process. The bill would require the administrative director, in consultation with the Commission on Health and Safety and Workers' Compensation, to adopt regulations to implement these provisions.