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 provider's request, the bill shall be reprocessed and paid, as specified.

Statutes affected:
03/24/25 - Amended Assembly: 4603.6 LAB, 4603.6 LAB
04/10/25 - Amended Assembly: 4603.6 LAB
09/05/25 - Amended Senate: 4603.3 LAB, 4603.3 LAB, 4603.6 LAB