CA [R] SB 1160 – Workers Compensation

Commentary- It’s important to establish responsibility for not only the injured worker which seems to be set forth much more clearly, but also for those who control the injured workers life in care, ongoing care, and quality of life. This must include employers, insurance adjusters, attorney’s and those who set back the process of diagnosis, healing, and access to proper and timely care for these injured workers without delay, denials, or stall tactics.

Number: CA [R] SB 1160 – Workers Compensation
Updated (Status 09/10/2016) Sponsor: Sen. Tony Mendoza (DEM-CA)
Introduced by Senator Mendoza
(Principal coauthor: Senator Pan)


February 18, 2016

An act to amend Sections 138.4, 138.6, 4610.5, 4610.6, 4903.05, 4903.8, 5307.27, 5710, 5811, and 6409 of, to amend, repeal, and add Section 4610 of, and to add Section 4615 to, the Labor Code, relating to workers’ compensation.

According to the Legislative Counsil Digest 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 the administrative director to develop and make available informational material written in plain language that describes the overall workers’ compensation claims process, as specified.
This bill would require the administrative director to adopt regulations to provide employees with notice regarding access to medical treatment following the denial of a claim under the workers’ compensation system.
Existing law requires the Administrative Director of the Division of Workers’ Compensation of the Department of Industrial Relations to develop a workers’ compensation information system in consultation with the Insurance Commissioner and the Workers’ Compensation Insurance Rating Bureau, with certain data to be collected electronically and to be compatible with the Electronic Data Interchange System of the International Association of Industrial Accident Boards and Commissions. Existing law requires the administrative director to assess an administrative penalty of not more than $5,000 in a single year against a claims administrator for a violation of those data reporting requirements.
This bill would increase that penalty assessment to not more than $10,000. The bill would require the administrative director to post on the Division of Workers’ Compensation Internet Web site a list of claims administrators who are in violation of the data reporting requirements.
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, delay, 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 revise and recast provisions relating to utilization review, as specified, with regard to injuries occurring on or after January 1, 2018. Among other things, the bill would set forth the medical treatment services that would be subject to prospective utilization review under these provisions, as provided. The bill would authorize retrospective utilization review for treatment provided under these provisions under limited circumstances, as specified. The bill would establish procedures for prospective and retrospective utilization reviews and set forth provisions for removal of a physician or provider under designated circumstances. On and after January 1, 2018, the bill would establish new procedures for reviewing determinations regarding the medical necessity of medication prescribed pursuant to the drug formulary adopted by the administrative director, as provided. The bill would make conforming changes to related provisions to implement these changes.

The bill would, commencing July 1, 2018, require each utilization review process to be accredited by an independent, nonprofit organization to certify that the utilization review process meets specified criteria, including, but not limited to, timeliness in issuing a utilization review decision, the scope of medical material used in issuing a utilization review decision, and requiring a policy preventing financial incentives to doctors and other providers based on the utilization review decision. The bill would require the administrative director to adopt rules to implement the selection of an independent, nonprofit organization for accreditation purposes, as specified. The bill would authorize the administrative director to adopt rules to require additional specific criteria for measuring the quality of a utilization review process for purposes of accreditation and provide for certain exemptions. The bill would require the administrative director to develop a system for electronic reporting of documents related to utilization review performed by each employer, to be administered by the division. The bill would require the administrative director, on or after March 1, 2019, to contract with an outside independent research organization to evaluate and report on the impact of provision of medical treatment within the first 30 days after a claim is filed, for claims filed on or after January 1, 2017, to January 1, 2019. The bill would require the report to be completed before January 1, 2020, and to be distributed to the administrative director, the Senate Committee on Labor and Industrial Relations, and the Assembly Committee on Insurance.
Existing law requires every lien claimant to file its lien with the appeals board in writing upon a form approved by the appeals board. Existing law requires a lien to be accompanied by a full statement or itemized voucher supporting the lien and justifying the right to reimbursement, as specified.
This bill would require certain lien claimants that file a lien under these provisions to do so by filing a declaration, under penalty of perjury, that includes specified information. The bill would require current lien claimants to also file the declaration by a specified date. The bill would make a failure to file a declaration under these provisions grounds for dismissal of a lien. Because the bill would expand the crime of perjury, the bill would impose a state-mandated local program.
The bill would also automatically stay any physician or provider lien upon the filing of criminal charges against that person or entity for specified offenses involving medical fraud, as provided. The bill would authorize the administrative director to adopt regulations to implement that provision. The bill would state findings and declarations of the Legislature in connection with these provisions.
Existing law prohibits the assignment of a lien under these provisions, except under limited circumstances, as specified.
This bill would, for liens filed after January 1, 2017, invalidate any assignment of a lien made in violation of these provisions, by operation of law.
Existing law requires the administrative director, in consultation with the Commission on Health and Safety and Workers’ Compensation, to adopt, after public hearings, a medical treatment utilization schedule to incorporate evidence-based, peer-reviewed, nationally recognized standards of care recommended by the commission, as specified.
This bill would authorize the administrative director to make updates to the utilization schedule by order, which would not be subject to the Administrative Procedure Act, as specified. The bill would require any order adopted pursuant to these provisions to be published on the Internet Web site of the division.
Existing law requires a deponent to receive certain expenses and reimbursements if an employer or insurance carrier requests a deposition to be taken of an injured employee, or any person claiming benefits as a dependent of an injured employee. Existing law authorizes the deponent to receive a reasonable allowance for attorney’s fees, if represented by an attorney licensed in this state.
This bill would authorize the administrative director to determine the range of reasonable fees to be paid to a deponent.
Existing law provides that it is the responsibility of any party producing a witness requiring an interpreter to arrange for the presence of a qualified interpreter. Existing law sets forth the qualifications of a qualified interpreter for these purposes, and provides for the settings under which a qualified interpreter may render services.
This bill would require the administrative director to promulgate regulations establishing criteria to verify the identity and credentials of individuals that provide interpreter services under these provisions.
Existing law requires physicians, as defined, who attend to injured or ill employees to file reports with specific information prescribed by law.
This bill would revise those reporting requirements, as prescribed.
This bill would incorporate changes to Section 4610 of the Labor Code proposed by AB 2503, to be operative as specified if both bills are enacted.
Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.
This bill would make legislative findings to that effect.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.

For more information-
Bill Text
The people of the State of California do enact as follows:
Read the full text –

See references:

State Pain Policy Advocacy Network (SPPAN)

Los Angeles Network of Care

LegInfo Legislature CA.Gov

Blog: Daisy Bill

~Update brought to you by iPain Advocacy Committee, International Pain Foundation


Ohana (For Dr. Earl Bakken)

by Twinkle VanFleet

Twinkle VanFleet 2015 Bakken Invitation Award Honoree_1

Front and back

He validated the spirit
And it’s heart
And restored the breath
Of a nearing depart

Acknowledging the path
And it’s hope
Diversity rising
It’s a slippery slope

Catching the reason
Determination and light
In giving to others
The fire and flight


Life, love, and empathy
We have to discuss
On all of us

7, 8, 9
Losing time
Your paradigm

Break down,
Nothing on me
Fight and fall,
Nope pain can’t stop she

Crazy, maybe, perception
Not really though
Trinity, affinity
Visions and missions to lead for

She’s rising,
They know she(‘s) flying
As above, so below
The gift of devising

Got you
Got us
Got me

Honi; spirit and power
The honoring art
Ha; the breath of life
A spiritual kiss of the hearts

Who could have known
It wasn’t alone
Ohana means family
Family is home.

For Dr. Earl Bakken, Medtronic Philanthropy, #LiveOnGiveOn

With love and admiration on behalf of myself and #iPain


©2016 Twinkle VanFleet/Golden Rainbow Poetry/All rights reserved. Copyright Laws and Regulations of the United States  May be shared. Permission required for any other use.

Ohana means family. Family means no one left behind… or forgotten.

My Month In Review- July 13 – August 14, 2015

My Month In Review- July 13 – August 14, 2015

I spent nearly 8 hours with my mom, dad, and sister-niece July 22, 2015, It was the last day. Mom, Dad. Rosie, my husband Erik and I went up to our daughter Kharisma’s job so they could say “love you”, not goodbye. Erik and I left them at the hotel about 10:50 p.m. that night. They finally arrived from Georgia the evening of Monday, July 13, 2015. We spent that evening together. We also spent the next 2 days together. We parted until we spent another 2 hours together when they arrived for our grandson De’Mantai’s baseball game. We parted again. They stayed with my step brother that week. During that week though mom was able to meet with her brother who she has not seen since the passing of my aunt, her sister in 2003. She was also able to meet up with her sister and her niece who she hadn’t seen since either. I didn’t see her at all that week but I am so glad she was able to see her family, go by the house she grew up in, which also happens to be the same one I did as a little girl from the second grade to the start of high school.

I hope that the time will come again that we can all be together at least one more time. But we know this might have been it. And for this reason, so many wonderful photos were taken to last a lifetime.


I’ve postponed one surgery for another complication.


Our oldest daughter, who turned 27 just a few months ago was put out of work a few days ago for a minimum of 3 months for her Epithelioid Hemangioendothelioma (EHE). It seems to be metastasizing. The several lesions on her liver. One in her kidney, a splenule spleen. Partial collapse of her lungs. Swelling, pain of course, but know what? It’s never over until it’s over.

We are #StrongerThanPain


Working on some exciting projects. Privileged to develop the strategy for the Power of Pain Foundation. Blessed to have people acknowledge my abilities and offer me opportunities to try while acknowledging that minimal time can be spent doing it. Yet, also believing that the minimal allotted availability is wholeheartedly used for the project or another given task.


Assisting in legislative efforts via POPF, SPPAN, and other collaborative efforts to provide information, awareness and hopeful change in matters affecting pain care.


Announcing the West Coast PAIN Summit 2015, Elk Grove, CA – More Info on NERVEmber 14, 2015

West Coast P.A.I.N. Summit
Access to Care, Advocacy and Neuromodulation 2015
Hosted by the Power of Pain Foundation and Medtronic Neuromodulation Therapies
Saturday, NERVEmber 14, 2015
Elk Grove Public Library Conference and Meeting Room
8900 Elk Grove Blvd.
Elk Grove, CA 95624
Elk Grove Library, Elk Grove, CA

Questions: Contact Twinkle VanFleet Director


Our daughter Rikki is doing well as a Coroner’s Assistant. Ozra is thriving in work, goals, his future, and advancement/ promotion in the Sacramento Sheriff’s Department Explorer’s Program leading and teaching others. I’m so proud of all 3 of you.


I did do something without revealing a peep to anyone. I went through the application process on my own, the interview process, and was accepted on another team. It is independent of the Power of Pain Foundation. It is something I have put off for a few years, but had been asked to consider on a personal level by those associated. I’ve been on board since August 4, 2015. I’ll officially be available on August 24, 2015 or there about for this position. It’s not a paid position. An Ambassador for patient relations. It’s providing my knowledge and experiences to other’s who are either considering or are already using the therapy. I will not be providing any professional, medical, or technical answers. I’m very much looking forward to being a part of this team.





TwinkleV and Melody T (Daughter and Mom) July 15, 2015_A

I miss my mama. Wednesday, July 15, 2015. 2 days after they arrived. Sitting outside together.


De'Mantai, Mom, Kharisma and Rikki (Greatgrandson, Grandma, Granddaughters) July 13, 2015_A



Our Grandson De’Mantai Xayvier (‘Tai) who met his Mimi (Grandma) for the very first time, our oldest daughter, Kharisma, my Mama (center), and our daughter, Rikki. Outside together.


TwinkleV, OzraV, Mom, and KharismaV July 13, 2015_3-a



Me, our son Ozra (Kurtis), our daughter Kharisma, and Mama (Melody)


Happy 28th Wedding Anniversary Master!


“When you think you can’t, maybe you already have” ~TwinkleV/rsdcrpsfire

Power of Pain Foundation- ADF and Access to Care


AZ State Capitol BuildingADF

Power of Pain Foundation recognizes that Abuse Deterrent Formulations are only a step forward
toward drug diversion. We know this isn’t the final answer. It allows an option for patients to
continue to be treated with opioid analgesics and removes many of the barriers involved in non abuse
deterrent medication.


POPF Pain Community Needs Assessment Survey

We are not focusing on any one treatment option, we are improving upon the patient/provider

The purpose of our survey was to determine who is having trouble getting access to quality care.
who is being dismissed, who is being cared for by a primary physician, who is being sent to pain
management and who is having difficulty receiving ongoing pain care.

We are aware of many individuals who are not receiving proper medication management or treatment
and others who had been receiving care that are now facing obstacles.

Our goal is continued access to care. Our goal is patient empowerment.

Recent Articles



The Unintended Side Effects of Fighting Prescription Drug Abuse by Twinkle VanFleet







Barby Ingle: Tamper-proof pain drugs deserve support
With the Power of Pain Foundation as a sponsor of the new bill AB 623 on Abuse Deterrent
Formulations, the above article  Op-Ed by our President has special significance being published 2/28/2015.

Our President also wrote articles for for WA, NV, AZ, and CA.
She wrote letters to legislators in MD, MO, UT, CO, AZ.
We are committed to you!


Power of Pain Foundation Advocacy Committee
Twinkle VanFleet, Board Member, Advocacy Chariwoman