Opinion ID: 1801902
Heading Depth: 4
Heading Rank: 2

Heading: Evolution of the Review Process Demonstrates Legislature's Intent

Text: Understood against this historical backdrop, it is clear the Legislature intended for employers to resolve treatment requests via the section 4610 process. As discussed above, Senate Bill Nos. 228 and 899 were aimed at controlling skyrocketing costs while simultaneously ensuring workers' access to prompt, quality, standardized medical care. To accomplish those goals, the Legislature made a number of significant changes, the most relevant of which was adopting the comprehensive utilization review process in section 4610 along with the concomitant changes to the dispute resolution procedure in section 4062. In place of the often lengthy and cumbersome process employers used to dispute treatment requests prior to the passage of Senate Bill No. 228, the Legislature created a utilization review process that combines what are typically quick resolutions (§ 4610, subd. (g)(1)) with accuracyemployers can have their utilization review doctors review treatment requests, employers can seek additional time to obtain additional information or examinations ( id., subd. (g)(5)), and medical review is required before the utilization review doctor can modify, delay, or deny a treatment request ( id., subd. (e)). State Fund asserts that there are instances when, or reasons why, it might not be reasonable to subject a treatment request to the utilization review process. We are not persuadedindeed, the cited examples betray a fundamental misunderstanding of the scope of utilization review and its requirements. For example, State Fund claims that if the employer determines, without [utilization review], that the recommended treatment is reasonably required, `imposing the [utilization review] process would be both time consuming and expensive.' But when the employer in the hypothetical reviews the request and determines that treatment is reasonably required, the employer has engaged in utilization review. (See § 4610, subd. (a).) The hypothetical actually demonstrates that utilization review provides an expeditious manner of resolving treatment requests, being neither time consuming nor expensive, especially when compared to the process previously in place. In light of the comprehensive nature of section 4610 and the goals the Legislature sought to accomplish, we conclude the Legislature intended for the utilization review process to be employers' only avenue for resolving an employee's request for treatment. (5) We also conclude that section 4062 is not available to employers as an alternative avenue for disputing employees' requests for treatment. The Legislature made clear that an employer may not use section 4062 to object to a medical determination concerning medical issues subject to section 4610 while expressly permitting employees to use section 4062 to resolve disputes over an employer's decision not to approve treatment requests (Stats. 2004, ch. 34, § 14)i.e., the plain language of section 4062 establishes that only employees may use section 4062 to resolve disputes over requests for treatment. This limitation is made even clearer when the current section 4062 is compared to previous versions. Former section 4062 allowed employers to object to medical determinations concerning the extent and scope of medical treatment.... (Stats. 2003, ch. 639, § 17.) In Senate Bill No. 899, the Legislature deleted that phrase. (Stats. 2004, ch. 34, § 14.) We presume the Legislature intends to change the meaning of a law when it alters the statutory language [citation], as for example when it deletes express provisions of the prior version.... ( Dix v. Superior Court (1991) 53 Cal.3d 442, 461 [279 Cal.Rptr. 834, 807 P.2d 1063].) State Fund would have us read the extent and scope of medical treatment back into the statute as one of the matters employers may object to under section 4062. We decline to do so. (6) Accordingly, in light of the clear statutory language and the Legislature's purpose in enacting the utilization review process in section 4610, we conclude the Legislature intended to require employers to conduct utilization review when considering employees' requests for medical treatment. Employers may not use section 4062 as an alternative method for disputing employees' treatment requests.