The Risk in A.M. Best's Innovation Scoring

Workers' Compensation Insights is the publication of Prop 23 Advisors.   Subscribers will receive in depth analyses of pending California legislation and regulations, review of important WCAB and appellate court decisions, and commentary on trends within the system both nationally and in California. Insights is published bi-monthly subject to the timing of significant legislative activity in Sacramento.

Workers Compensation Insights

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California Legislation Takes on WC Physician Network Management.  Assembly Bill 2294 (Salas) is the latest legislative proposal taking aim at the management of medical provider networks (MPNs). This is not a new issue, and indeed was looked at by the Legislature as recently as last year with Senate Bill 537 (Hill). The murky environment of provider networks and provider contracts may very well need further examination. This could include revisiting the now 20-year old language in Labor Code § 4609 relating to provider contracts and “contracting agents.” It may also compel an examination of such seemingly unrelated issues as statutory accounting for insurance companies and estimates of future liability for self-insureds.

While some may take a Marie Antoinette approach and suggest disgruntled providers should go to their nearest bakery if they do not like their reimbursement rates, that offers no assistance in the current debate. There is a fairly elaborate structure in the Labor Code regarding networks, fee schedules, contracts for reimbursement rates different from fee schedules, access to provider requirements, and the submission and resolution of payment requests. This architecture may not lend itself, from a policy standpoint, to contractual work arounds if those work arounds are not the result of arm’s length contractual relationships and are not in furtherance of policy decisions made over the years by the Legislature.

On the other hand, if providers simply are asking the Legislature to put a finger on the scale, then this is an issue stakeholders could rightfully ignore.      ​

​​​​​​​​​​​​In this Edition of Insights:

  • California Legislature bill introductions are slow to emerge - deadline is February 21.
  • Cal/OSHA issues Coronavirus guidance. 
  • Privacy law makes it way into data breach litigation in California.
  • Workers' compensation predictions for 2020.
  • U.S. House of Representatives passes ABC Test for federal standard - Senate not likely to concur.

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