AB 1048: Workers’ compensation.

Session Year: 2025-2026
House: Assembly

Current Status:

In Progress

(2025-09-08: Read second time. Ordered to third reading.)

Introduced

First Committee Review

First Chamber

Second Committee Review

Second Chamber

Enacted

Version:

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 requires an employer to provide medical, surgical, chiropractic, acupuncture, and hospital treatment that is reasonably required to cure or relieve the injured worker from the effects of the injury. Upon payment, adjustment, or denial of a complete or incomplete itemization of medical services, existing law requires an employer to provide an explanation of review that includes, among other information, the amount paid and the basis for any adjustment, change, or denial of the item or procedure billed.

This bill would, when the basis for any adjustment, change, or denial of an item or procedure is a contract, require the explanation of review to include information on that underlying contract, including whom the medical provider may contact to seek a copy of the relevant, applicable contract. The bill would state that disclosure of a medical provider network does not satisfy this requirement and would state that if the contract is not received within 30 business days of the providers request, the bill shall be reprocessed and paid, as specified.

Existing law establishes a workers compensation system, administered by the Administrative Director of the Division of Workers Compensation, within the Department of Industrial Relations, to compensate an employee for injuries sustained in the course of their employment. Among other things, the workers compensation system provides for medical and hospital treatment, disability payments, and death benefits, as specified.Existing law requires the administrative director to contract with one or more independent bill review organizations to conduct reviews of medical providers in accordance with specified criteria. Existing law authorizes a provider under certain circumstances, including when the amount of payment is in dispute, to request an independent bill review within a specified timeframe. Existing law requires that the medical provider pay to the administrative director a fee to cover the reasonable estimated cost of the independent bill review and the administration of the independent bill review program. Existing law requires the administrative director to adopt and revise periodically an official medical fee schedule establishing reasonable maximum fees paid for medical services other than physician services, drugs and pharmacy services, health care facility fees, home health care, and all other treatment, care, services, and goods.This bill would define a payment dispute to include a contract dispute involving any discount or reduction from the official medical fee schedule. The bill would also require, if the dispute only involves a percentage discount or reduction that results in the independent bill review upholding the decision, the independent review organization to provide a written decision to the medical provider and include the medical provider contract relied upon to uphold the decision.

Discussed in Hearing