SB 863: What Injured Workers Need to Know

Senate Bill 863 was signed into law by Governor Jerry Brown on September 18, 2012, and took effect for most claims on January 1, 2013. It is still the framework for California workers’ compensation. If you are hurt on the job today, SB 863 decides how your medical treatment is approved, how disputes over that treatment are resolved, and how your permanent disability is calculated.

What SB 863 changed, and what still applies

• Medical treatment disputes go to independent medical review (IMR). Before SB 863, a workers’ compensation judge could decide whether you needed a surgery, a medication or physical therapy. Now, when the insurer’s utilization review (UR) denies or modifies a request, the dispute goes to a physician reviewer through IMR. Judges can still step in when a UR decision is late or procedurally defective. Learn how IMR works.
• Permanent disability is rated differently. For injuries on or after January 1, 2013, every whole-person impairment is multiplied by a fixed 1.4 adjustment, replacing the old “diminished future earning capacity” factor. Add-on ratings for sleep problems, sexual dysfunction and psychiatric injury that grow out of a physical injury were sharply limited. Permanent disability ratings explained.
• Retraining vouchers were standardized. Workers injured on or after January 1, 2013 who are not offered regular, modified or alternative work receive a $6,000 Supplemental Job Displacement Benefit voucher. Those workers may also qualify for a separate $5,000 Return-to-Work Supplement payment.
• Doctor choice and networks changed. SB 863 revised the rules for medical provider networks (MPNs) and for pre-designating your own physician before an injury. Pre-designation form (DWC 9783).
• Liens and billing disputes were overhauled, with new filing fees and an independent bill review process meant to clear the backlog of provider liens.

Why it still matters

SB 863 was negotiated by large employers and unions, and it raised permanent disability payments. It also gave insurers more control over medical care, and most of the disputes our clients face today trace back to its UR and IMR system. A denied request has short deadlines. Missing one can cost you treatment, so it is worth talking to an attorney as soon as care is delayed or denied. Our workers’ compensation attorneys have handled SB 863 claims since the day it took effect, and Partner Adam Dombchik, a past president of the California Applicants’ Attorneys Association, helped educate the legal community about the law as it was implemented.

Our SB 863 coverage

• Senate Bill 863: Governor Brown and the Legislature Reform Workers’ Compensation… Again (Sept. 2012)
• We Must Stand Up Now Against SB 863 (Aug. 2012)
• How the proposed legislation would harm injured teachers and school employees (Aug. 2012)
• New Workers’ Compensation Law Leads to Independent Medical Review Process (Feb. 2013)
• Labor Code Inclusion Is a Positive Aspect of Senate Bill 863 (Feb. 2013)
• SB 863 Changes the Supplemental Job Displacement Voucher Benefit (Mar. 2013)
• Know Your Rights to Medical Treatment for Work-Related Injuries (Jul. 2013)
• Taking a Creative Look at SB 863 and Independent Medical Review (Aug. 2013)
• The Problem with IMR Is UR (Oct. 2013)
• Understanding Independent Medical Review: Fighting for Medical Care (Jan. 2014)
• Final Regulations Set for the IMR Process (Mar. 2014)
• Legal Challenges Are Made to the Medical Treatment Dispute Resolution Process (May 2015)
• Court of Appeal to Hear Arguments on the Constitutionality of IMR (Sept. 2015)
• Court Clarifies Procedure for Spinal Surgery Disputes (2006, pre-SB 863 background)

More: all medical care, UR and IMR articles · Utilization review guide · IMR application form