Existing law makes it a misdemeanor or a felony to engage in specified acts of fraud or material misrepresentation for the purpose of obtaining or denying workers' compensation, as specified. Existing law, the Workers' Compensation Insurance Fraud Reporting Act (the act) , requires insurers and licensed rating organizations to release upon request to an authorized governmental agency, as defined, relevant information deemed important to the authorized governmental agency that the insurer or licensed rating organization may possess relating to any specific workers' compensation insurance fraud investigation. The act requires, under specified circumstances, an insurer or licensed rating organization to notify the local district attorney's office and the Fraud Division of the Department of Insurance, and requires that entity, unless specified circumstances exist, to notify any other authorized governmental agency of suspected fraud, as specified. The act also requires the Employment Development Department (EDD) to release, upon written request, to an authorized governmental agency relevant information that the EDD may possess relating to any specific workers' compensation insurance fraud investigation. The act requires, unless specified circumstances exist, an authorized governmental agency that is provided with information pursuant to those provisions to release or provide that information in a confidential manner to any other authorized governmental agency for purposes of investigation, prosecution, or prevention of insurance fraud or workers' compensation fraud. This bill would require an insurer or licensed rating organization to notify the EDD, in addition to the local district attorney's office and Fraud Division on the Department of Insurance, of suspected fraud when the fraudulent act relates to premium fraud. The bill would authorize an insurer to submit wage records and employee counts for an employer to the EDD and would require the EDD to identify discrepancies in the submitted information, as specified, and report any discrepancies back to the submitting insurer. Upon request by an insurer, the bill would require the EDD to release or provide detailed payroll information, including payroll summary totals, allowing the requester to compare the records with the information they are otherwise entitled to receive from employers in workers' compensation claims or pursuant to workers' compensation policies, unless doing so would violate federal law or compromise an ongoing investigation. The bill would require the EDD to only provide the information if specified requirements are met, and the requesting insurer to reimburse the department's actual, direct costs of releasing or providing this information. The bill would prohibit the provided documents from being used for specified purposes. Existing federal regulations generally prohibit the disclosure of confidential unemployment compensation information unless disclosure is on the basis of, among other things, informed consent to an agent of an employer. This bill would provide that by entering into a policy of workers' compensation insurance with an insurer, an employer in California consents and designates that insurer as the employer's agent to act for or in the place of the employer only with respect to a request for the above-described payroll information. Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest. This bill would make legislative findings to that effect.
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 employment, which, in the case of the death of an employee, includes a death benefit. Existing law governs temporary and permanent disability indemnity payments and prohibits a payment made by a written instrument unless it is immediately negotiable and payable in cash, among other things. Existing law, until January 1, 2027, allows an employer to commence a program under which disability indemnity payments are deposited in a prepaid card account for employees. This bill would extend the authorization to deposit indemnity payments in a prepaid card account indefinitely.
Existing unemployment compensation disability law requires workers to pay contribution rates based on, among other things, wages received in employment and benefit disbursement, for payment into the Unemployment Compensation Disability Fund, a special fund in the State Treasury. That fund is continuously appropriated for the purpose of providing disability benefits and making payment of expenses in administering those provisions. Existing law, the family temporary disability insurance program, provides up to 8 weeks of wage replacement benefits to workers who take time off work to care for a seriously ill child, spouse, parent, grandparent, grandchild, sibling, or domestic partner, or to bond with a minor child within one year of birth or placement in connection with foster care or adoption, or to participate in a qualifying exigency related to the covered active duty or call to covered active duty of the individual's spouse, domestic partner, child, or parent in the Armed Forces of the United States. Existing law defines "covered active duty" to mean, with respect to a member of the regular Armed Forces of the United States, duty during the deployment of the member with the regular armed forces to a foreign country and, with respect to a member of the reserve components of the Armed Forces of the United States, duty during the deployment of the member of those reserve components to a foreign country under a federal call or order to active duty. This bill would, starting upon specified changes to the Employment Development Department's integrated claims management system or on July 1, 2028, whichever occurs sooner, expand the definition of "covered active duty" to additionally include duty during training, deployment other than deployment to a foreign country, and, with respect to a member of the reserve components of the Armed Forces of the United States, a call or order to state active duty. By authorizing expenditures from the continuously appropriated fund for these expanded purposes, this bill would make an appropriation.
Existing law establishes a workers' compensation system, administered by the Administrative Director of the Division of Workers' Compensation, to compensate an employee, as defined, for injuries that arise out of, and in the course of, employment. Existing law requires employers to provide medical, surgical, chiropractic, acupuncture, licensed clinical social worker, and hospital treatment reasonably required to cure or relieve the injured worker from the effects of the injury. Existing law makes it a misdemeanor for an employer to discharge, threaten to discharge, or discriminate against, or for an insurer to advise, direct, or threaten an insured to discharge, an employee because they have filed or made known their intention to file a claim for compensation, or an application for adjudication, or because the employee has received a rating, award, or settlement, as specified. This bill would require an employee, when possible, to make a reasonable effort to schedule treatment outside of work hours. The bill would require the employee, if the timing of the treatment is foreseeable, to provide notice if treatment occurs during work hours, as specified, and require the employer to provide this leave during work hours unless business necessity requires the treatment to occur at a different time or on a different day. The bill would require that the leave taken by an employee pursuant to these provisions run concurrently with leave taken pursuant to the federal Family and Medical Leave Act of 1993 and the California Family Rights Act if the employee would have been eligible for that leave. If an employer denies an employee's request to attend scheduled treatment, and the employer knows or should know that a business necessity does not require the treatment to occur at a different time or on a different day, the bill would make that denial a misdemeanor. The bill would also make it a misdemeanor for an employer to discharge, threaten to discharge, or discriminate against an employee because the employee requested or took leave pursuant to these provisions. By creating new crimes, this bill would impose a state-mandated local program. The bill would make other conforming changes. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason.
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 employment. Existing law provides certain methods for determining workers' compensation benefits payable to a worker or the worker's dependents for purposes of permanent total disability or permanent partial disability that include a determination of the percentage of permanent disability incurred. Existing law requires that, for injuries incurred before January 1, 2013, in determining the percentages of permanent disability, account be taken of the nature of the physical injury or disfigurement, the occupation of the injured employee, and the injured employee's age at the time of the injury, and requires that specified factors be considered in determining an employee's diminished earning capacity for these purposes. For purposes of these provisions, "nature of the physical injury or disfigurement" incorporates the descriptions and measurements of physical impairment and the corresponding percentages of impairments published in the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment (5th Edition) . For injuries occurring on or after January 1, 2013, in determining the percentages of permanent disability, existing law requires the same factors be taken into account but removes from consideration the employee's diminished future earning capacity and, instead, incorporates an adjustment factor of 1.4, as specified. Existing law also establishes the Subsequent Injuries Benefits Trust Fund, a continuously appropriated fund. Under existing law, if a permanently, partially disabled employee receives a subsequent compensable injury resulting in additional permanent disability, then that employee receives compensation from the Subsequent Injuries Benefits Trust Fund. Existing law requires, when applicable, the additional permanent disability resulting from the subsequent injury to be equal to 35% or more of total, when considered alone and without regard to, or adjustment for, the occupation or the age of the employee. For purposes of determining permanent disability resulting from a subsequent injury, this bill would measure permanent disability, for injuries occurring on or after January 1, 2005, and prior to January 1, 2013, by the whole person impairment rating as determined in accordance with the AMA Guides to the Evaluation of Permanent Impairment (5th Edition) , after adjustment for diminished future earning capacity and without regard to, or adjustment for, the occupation or age of the employee. For injuries occurring on or after January 1, 2013, the bill would measure permanent disability in the same manner as an injury occurring on or after January 1, 2005, and prior to January 1, 2013, except that an adjustment for diminished future earning capacity is replaced by the 1.4 adjustment factor. The bill would state that these provisions are declarative of existing law. To the extent the bill changes the eligibility requirements for and calculation for payments made from the Subsequent Injuries Benefits Trust Fund, the bill would make an appropriation. This bill would, for compensable subsequent injuries occurring on or after January 1, 2027, require, for purposes of determining eligibility for and the amount of an award of special additional compensation, the existence of the prior permanent partial disability at the time of the subsequent compensable injury to be determined by substantial evidence, based on medical records, testimony, or other evidence, that the prior permanent partial disability predated the subsequent compensable injury and that the prior permanent partial disability resulted in loss of earnings, interfered with work activities, or otherwise impacted the ability of the employee to perform work activities or activities of daily living. The bill would require the administrative director to create and maintain a database of qualified medical evaluators to perform evaluations for claims filed for a subsequent compensable injury. The bill would make conforming changes. Existing law requires the WCAB to fix and award the amounts of special additional compensation to be paid and to direct the State Compensation Insurance Fund (SCIF) to pay the additional compensation awarded. Existing law authorizes the additional compensation to be paid only from funds appropriated for these purposes. Existing law authorizes SCIF to reimburse itself for specified costs from this appropriation. This bill would replace SCIF with the Director of Industrial Relations, as trustee of the Subsequent Injuries Benefits Trust Fund, as the entity to pay the additional compensation awarded by the WCAB. The bill would delete SCIF's authorization to reimburse itself for specified costs.
Existing law designates various persons as peace officers, including officers of a state hospital under the jurisdiction of the State Department of State Hospitals or the State Department of Developmental Services. 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 their employment. Existing law creates a disputable presumption, applicable to officers and employees in the Department of Corrections and Rehabilitation, that heart trouble that develops or manifests during a period when the employee is in the service of the department arose out of and in the course of employment. This bill would add to the above-described presumption a peace officer, as defined, employed by the State Department of State Hospitals and would make other conforming and technical changes.
Existing law establishes a workers' compensation system, administered by the Administrative Director of the Division of Workers' Compensation, to compensate an employee for injuries arising out of and in the course of their employment. Existing law establishes procedures for the resolution of disputes regarding the compensability of an injury, including the use of a qualified medical evaluator (QME) to perform a comprehensive medical-legal evaluation to address all contested medical issues arising from all injuries reported in a claim. Existing law requires all communications with a panel QME before a medical evaluation to be in writing served on the opposing party 20 days in advance of the evaluation, and any subsequent communication with the QME to be in writing and served on the opposing party when the communication is sent to the QME. This bill would require the administrative director to develop and make available a medical evaluation request form for communicating with a panel qualified medical evaluator in advance of an evaluation obtained pursuant to the above provisions. The bill would require the administrative director to develop and make available a template QME report form, which will include all necessary statutory and regulatory requirements for a QME report. The bill would require the Division of Workers' Compensation to adopt regulations to implement these provisions by January 1, 2027.
Existing law establishes a workers' compensation system, administered by the Administrative Director of the Division of Workers' Compensation, to compensate an employee, as defined, for injuries sustained in the course of employment. Existing law provides that it is unlawful for a physician to refer a person for specified medical goods or services whether for treatment or medical-legal purposes if the physician or their immediate family has a financial interest with the person or in the entity that receives the referral, except in prescribed circumstances. Existing law requires all interested parties, as defined, to disclose any financial interest in any entity providing services. A violation of these provisions is a misdemeanor. This bill would require all interested parties to provide written disclosure of their financial interest, if any, to a third-party payer or other entity to whom a claim for payment is presented for services furnished pursuant to a referral. By changing the definition of a crime, this bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason.
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 employment. Under existing law, when a local employee who is a firefighter or peace officer, as specified, and that employee is killed or dies as a result of an accident or injury caused by external violence of physical force incurred in the performance of their duty, the employer is required to continue providing health benefits to the deceased employee's minor dependents under the benefits extended to the surviving spouse, or if there is no surviving spouse, until the minor dependent is 21 years of age. This bill would increase that age to 26 years of age.
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 employment. Existing law provides certain methods for determining workers' compensation benefits payable to a worker or the worker's dependents for purposes of permanent total disability or permanent partial disability that include a determination of the percentage of permanent disability incurred. Existing law requires that, for injuries incurred before January 1, 2013, in determining the percentages of permanent disability, account be taken of the nature of the physical injury or disfigurement, the occupation of the injured employee, and the injured employee's age at the time of the injury, and requires that specified factors be considered in determining an employee's diminished earning capacity for these purposes. For purposes of these provisions, "nature of the physical injury or disfigurement" incorporates the descriptions and measurements of physical impairment and the corresponding percentages of impairments published in the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment (5th Edition) . For injuries occurring on or after January 1, 2013, in determining the percentages of permanent disability, existing law requires the same factors be taken into account but removes from consideration the employee's diminished future earning capacity and, instead, incorporates an adjustment factor of 1.4, as specified. Existing law also establishes the Subsequent Injuries Benefits Trust Fund, a continuously appropriated fund. Under existing law, if a permanently, partially disabled employee receives a subsequent compensable injury resulting in additional permanent disability, then that employee receives compensation from the Subsequent Injuries Benefits Trust Fund. Existing law requires, when applicable, the additional permanent disability resulting from the subsequent injury to be equal to 35% or more of total, when considered alone and without regard to, or adjustment for, the occupation or the age of the employee. For purposes of determining permanent disability resulting from a subsequent injury, this bill would measure permanent disability, for injuries occurring on or after January 1, 2005, and prior to January 1, 2013, by the whole person impairment rating as determined in accordance with the AMA Guides to the Evaluation of Permanent Impairment (5th Edition) , after adjustment for diminished future earning capacity and without regard to, or adjustment for, the occupation or age of the employee. For injuries occurring on or after January 1, 2013, the bill would measure permanent disability in the same manner as an injury occurring on or after January 1, 2005, and prior to January 1, 2013, except that an adjustment for diminished future earning capacity is replaced by the 1.4 adjustment factor. The bill would state that these provisions are declarative of existing law. To the extent the bill changes the eligibility requirements for and calculation for payments made from the Subsequent Injuries Benefits Trust Fund, the bill would make an appropriation. This bill would, for compensable subsequent injuries occurring on or after January 1, 2026, require, for purposes of determining eligibility for and the amount of an award of special additional compensation, the existence of the prior permanent partial disability at the time of the subsequent compensable injury to be determined by substantial evidence, based on medical records, testimony, or other evidence, that the prior permanent partial disability predated the subsequent compensable injury and that the prior permanent partial disability resulted in loss of earnings, interfered with work activities, or otherwise impacted the ability of the employee to perform work activities or activities of daily living. For these compensable subsequent injuries occurring on or after January 1, 2026, the bill would require an employee to file an application for special additional compensation pursuant to these provisions within 5 years from the date of the subsequent compensable injury or one year from the date that the level of permanent disability arising from the subsequent compensable injury is determined by the Workers' Compensation Appeals Board (WCAB) , whichever occurs later. The bill would require the administrative director to create and maintain a database of qualified medical evaluators to perform evaluations for claims filed for a subsequent compensable injury. The bill would make conforming changes. Existing law requires the WCAB to fix and award the amounts of special additional compensation to be paid and to direct the State Compensation Insurance Fund (SCIF) to pay the additional compensation awarded. Existing law authorizes the additional compensation to be paid only from funds appropriated for these purposes. Existing law authorizes SCIF to reimburse itself for specified costs from this appropriation. This bill would replace SCIF with the Director of Industrial Relations, as trustee of the Subsequent Injuries Benefits Trust Fund, as the entity to pay the additional compensation awarded by the WCAB. The bill would delete SCIF's authorization to reimburse itself for specified costs.
