California is taking first steps toward implementing electronic systems for workers' compensation injury reports and what's called the "utilization review" process.
The systems are mandated by legislation passed in 2016. The bill's author, state Sen. Tony Mendoza, called SB 1160 "an important reform measure that will improve data collection and medical treatment delivery for California's injured workers."
Specifically, the Department of Industrial Relations (DIR) has been tasked with creating an electronic system that can accept Doctors' First Report of Injury documents. California's labor code "requires a physician who treats an injured employee to file a 'Doctor's First Report of Injury' (DFR) with the claims administrator for every work illness or injury, even first-aid cases where there is no lost time from work." The document looks like this.
DIR's Division of Workers' Compensation also proposes to to develop a system for electronic reporting of documents related for the utilization review process, which, according to a legislative summary, is the "review process for medical treatment recommendations by physicians to see if the request for medical treatment is medically necessary. The full UR process varies by vendor, but it generally involves initial review by a non-physician, with higher level review(s) being conducted by a physician or physicians."
Electronic reporting of utilization review data by claims administrators will enable the division to monitor claim processes and address problems, DIR said.
"SB 1160 will shine a bright light on how UR impacts claims, both systemwide and for specific employers and UR entities. This data will make possible targeted audits and legislative initiatives that address unnecessary medical disputes, while preserving important protections against unnecessary and abusive medical treatment," a summary analysis from the Senate Labor and Industrial Relations Committee found.
Both projects — the utilization review database and the electronic form for the Doctor's First Report of Injury — are subject to the Department of Technology's planning process before final approval and go-ahead.
The Department of Industrial Relations has launched a handful of other e-government projects in recent months, such as an online system where employers can file appeals of Division of Occupational Safety and Health (Cal/OSHA) citations, and another online system to make it easier for garment manufacturers to register with the state of California.
The state reported one year ago that Industrial Relations is one of the departments subscribing to the vendor-hosted Customer Relationship Management system and Microsoft Office 365 productivity suite, brokered by the Department of Technology.
