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 his or her employment. Existing law requires every employer to establish a utilization review process, and defines “utilization review” as utilization review or utilization management functions that prospectively, retrospectively, or concurrently review and approve, modify, or deny, based in whole or in part on medical necessity to cure and relieve, treatment recommendations by physicians, prior to, retrospectively, or concurrent with providing medical treatment services. Existing law also provides for an independent medical review process to resolve disputes over utilization review decisions, as defined.

This bill would exempt medical treatment for employees or first responders who sustain physical or psychological injury as a result of an act of terrorism or violence in the workplace workplace, as defined, from the utilization review process and the independent medical review process, and would provide for an expedited proceeding before the Workers’ Compensation Appeals Board to resolve disputes regarding treatment. The bill would also apply retroactively to the employees and first responders injured in the San Bernardino terrorist attack of December 2, 2015, and any other employees or first responders injured by an act of terrorism or violence in the workplace that occurs prior to January 1, 2018.

Existing workers’ compensation law generally requires employers to secure the payment of workers’ compensation, including medical treatment, for injuries incurred by their employees that arise out of, or in the course of, employment. Existing law prohibits aggregate disability payments for a single injury occurring on or after April 19, 2004, causing temporary disability from extending for more than 104 compensable weeks within a period of 2 years from the date of commencement of temporary disability payment. Existing law permits aggregate disability payments for certain injuries or conditions including, but not limited to, amputations, severe burns, and high-velocity eye injuries, to be made for not more than 240 compensable weeks within a period of 5 years from the date of the injury.

This bill would add physical or psychological injury arising from an act of terrorism or violence in the workplace workplace, as defined, to the list of injuries on or conditions for which aggregate disability payments may be made for not more than 240 compensable weeks within a period of 5 years from the date of injury.