In its original form, Assembly Bill 1107 was supposed to give relief to injured workers who were being wrongly denied access to treatment.

Robert Weinmann

It was supposed to ease the administrative burden on treating physicians whose time for patient care was being diluted by unreasonable requests for documentation to entertain utilization review (UR).

The main thrust of AB 1107 was to facilitate treatment by primary treating physicians by exempting them from UR under specific circumstances. This plank has now been removed and replaced by language that may actually increase legal costs. 

As a result of the fear that access to treatment might become too easy for injured workers, the bill was amended in committee with the acquiescence of the author to narrow the proposal but to allow stakeholders to challenge UR conclusions, which could include more legal wrangling with even less access to care, since treatment will inevitably be delayed, postponed or just not done while the wrangling process is in play. 

It is true that this proposal gives the applicant or patient an opportunity that wasn't previously available, but it does not facilitate prescribed treatment by treating doctors — and that, my friend, was supposed to have been the raison d'etre of AB 1107 in the first place. 

In the recent King v. CompPartners Inc. case, August of 2018, a deserving patient was harmed by wrongful utilization review when authorization for his medication was  withdrawn. The injured worker tried to use tort law to sue the UR provider but lost that battle when the California Supreme Court decided that work comp law provides  exclusive remedy for employees who allege injury because of treatment denial by UR.

This decision in turn caused one of the justices to say that the law for injured workers should be revisited.

That was what AB 1107 initially sought to do. Instead, we have a compromise that does not help injured workers when they need treatment, but which provides them and their lawyers a way to challenge UR decisions later. This solution is another in the sordid list of "too little, too late."

I recommend revisiting the bill again to review the circumstances under which UR can be set aside so that injured workers get needed care in timely fashion. There is still time to amend the amendment. 

Dr. Robert Weinmann writes the Politics of Healthcare blog, from which this entry was taken with permission.