Workers’ compensation.

Assembly Member Chen's workers' compensation reform measure adds new transparency requirements when employers adjust or deny medical bills based on contract terms. The legislation requires employers to include specific details about the underlying contract in their explanation of review, including contact information for obtaining contract copies. If employers fail to provide the requested contract within 30 business days, the bill mandates automatic reprocessing and payment at official fee schedule rates.

The measure builds upon existing requirements for explanations of review in workers' compensation cases, which already mandate that employers detail billed items, payment amounts, and reasons for adjustments. Under the new provisions, simply referencing a medical provider network would not satisfy the contract disclosure requirements. The bill preserves other existing elements of the explanation of review, including information about incomplete itemizations, non-fee dispute denials, and the process for independent review of disputed bills.

The administrative director of the Division of Workers' Compensation retains authority to implement these changes through regulation, including potential requirements for electronic submission of explanations of review. This maintains the existing regulatory framework while incorporating the new contract transparency provisions into the workers' compensation billing process.