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<ns0:SessionYear>2025</ns0:SessionYear>
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<ns0:AuthorText authorType="LEAD_AUTHOR">Introduced by Assembly Member Ortega</ns0:AuthorText>
<ns0:Authors>
<ns0:Legislator>
<ns0:Contribution>LEAD_AUTHOR</ns0:Contribution>
<ns0:House>ASSEMBLY</ns0:House>
<ns0:Name>Ortega</ns0:Name>
</ns0:Legislator>
</ns0:Authors>
<ns0:Title>An act to amend Sections 4751, 4753.5, 4754, and 4755 of, and to add Sections 4754.1 and 4754.2 to, the Labor Code, relating to workers’ compensation, and making an appropriation therefor.</ns0:Title>
<ns0:RelatingClause>workers’ compensation, and making an appropriation therefor</ns0:RelatingClause>
<ns0:GeneralSubject>
<ns0:Subject>Workers’ Compensation: Subsequent injuries payments.</ns0:Subject>
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<ns0:DigestText>
<html:p>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 employment. Existing law provides certain methods for determining workers’ compensation benefits payable to a worker or the worker’s dependents for purposes of permanent total disability or permanent partial disability that include a determination of the percentage of permanent disability incurred. Existing law requires that, for injuries incurred before January 1, 2013, in determining the percentages of permanent disability, account be taken of the nature of the physical injury or disfigurement, the occupation of the injured employee, and the injured employee’s age at the time of the injury, and requires that specified factors be considered in determining an employee’s diminished
earning capacity for these purposes. For purposes of these provisions, “nature of the physical injury or disfigurement” incorporates the descriptions and measurements of physical impairment and the corresponding percentages of impairments published in the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment (5th Edition). For injuries occurring on or after January 1, 2013, in determining the percentages of permanent disability, existing law requires the same factors be taken into account but removes from consideration the employee’s diminished future earning capacity and, instead, incorporates an adjustment factor of 1.4, as specified.</html:p>
<html:p>Existing law also establishes the Subsequent Injuries Benefits Trust Fund, a continuously appropriated fund. Under existing law, if a permanently, partially disabled employee receives a subsequent compensable injury resulting in additional permanent disability, then that employee receives compensation
from the Subsequent Injuries Benefits Trust Fund. Existing law requires, when applicable, the additional permanent disability resulting from the subsequent injury to be equal to 35% or more of total, when considered alone and without regard to, or adjustment for, the occupation or the age of the employee.</html:p>
<html:p>For purposes of determining permanent disability resulting from a subsequent injury, this bill would measure permanent disability, for injuries occurring on or after January 1, 2005, and prior to January 1, 2013, by the whole person impairment rating as determined in accordance with the AMA Guides to the Evaluation of Permanent Impairment (5th Edition), after adjustment for diminished future earning capacity and without regard to, or adjustment for, the occupation or age of the employee. For injuries occurring on or after January 1, 2013, the bill would measure permanent disability in the same manner as an injury occurring on or after January 1, 2005, and prior to
January 1, 2013, except that an adjustment for diminished future earning capacity is replaced by the 1.4 adjustment factor. The bill would state that these provisions are declarative of existing law. To the extent the bill changes the eligibility requirements for and calculation for payments made from the Subsequent Injuries Benefits Trust Fund, the bill would make an appropriation.</html:p>
<html:p>This bill would, for compensable subsequent injuries occurring on or after January 1, 2026, require, for purposes of determining eligibility for and the amount of an award of special additional compensation, the existence of the prior permanent partial disability at the time of the subsequent compensable injury to be determined by substantial evidence, based on medical records, testimony, or other evidence, that the prior permanent partial disability predated the subsequent compensable injury and that the prior permanent partial disability resulted in loss of earnings, interfered with
work activities, or otherwise impacted the ability of the employee to perform work activities or activities of daily living. For these compensable subsequent injuries occurring on or after January 1, 2026, the bill would require an employee to file an application for special additional compensation pursuant to these provisions within 5 years from the date of the subsequent compensable injury or one year from the date that the level of permanent disability arising from the subsequent compensable injury is determined by the Workers’ Compensation Appeals Board (WCAB), whichever occurs later. The bill would require the administrative director to create and maintain a database of qualified medical evaluators to perform evaluations for claims filed for a subsequent compensable injury. The bill would make conforming changes.</html:p>
<html:p>Existing law requires the
WCAB to fix and award the amounts of special additional compensation to be paid and to direct the State Compensation Insurance Fund (SCIF) to pay the additional compensation awarded. Existing law authorizes the additional compensation to be paid only from funds appropriated for these purposes. Existing law authorizes SCIF to reimburse itself for specified costs from this appropriation.</html:p>
<html:p>This bill would replace SCIF with the Director of Industrial Relations, as trustee of the Subsequent Injuries Benefits Trust Fund, as the entity to pay the additional compensation awarded by the WCAB. The bill would delete SCIF’s authorization to reimburse itself for specified costs.</html:p>
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<ns0:VoteRequired>MAJORITY</ns0:VoteRequired>
<ns0:Appropriation>YES</ns0:Appropriation>
<ns0:FiscalCommittee>YES</ns0:FiscalCommittee>
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<ns0:Preamble>The people of the State of California do enact as follows:</ns0:Preamble>
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<ns0:Num>SECTION 1.</ns0:Num>
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Section 4751 of the
<ns0:DocName>Labor Code</ns0:DocName>
is amended to read:
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<ns0:Num>4751.</ns0:Num>
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<html:p>
(a)
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If an employee who is permanently partially disabled receives a subsequent compensable injury resulting in additional permanent partial disability so that the degree of disability caused by the combination of both disabilities is greater than that which would have resulted from the subsequent injury alone, and the combined effect of the last injury and the previous disability or impairment is a permanent disability equal to 70 percent or more of total, the employee shall be paid in addition to the compensation due under this code for the permanent partial disability caused by the last injury compensation for the remainder of the combined permanent disability existing after the last injury as provided in this article, provided that either of the
following is satisfied:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
The previous disability or impairment affected a hand, an arm, a foot, a leg, or an eye, and the permanent disability resulting from the subsequent injury affects the opposite and corresponding member, and such latter permanent disability, when considered alone and without regard to, or adjustment for, the occupation or age of the employee, is equal to 5 percent or more of total.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The permanent disability resulting from the subsequent injury, when considered alone and without regard to, or adjustment for, the occupation or the age of the employee, is equal to 35 percent or more of total.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
For purposes of paragraphs (1) and (2) of subdivision (a), the term “permanent disability” in relation
to subsequent compensable injuries occurring on or after January 1, 2005, and prior to January 1, 2013, shall be measured by the whole person impairment rating, also referred to as the impairment standard, as determined in accordance with the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment, 5th Edition, after adjustment for diminished future earning capacity and without regard to, or adjustment for, the occupation or age of the employee.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
For purposes of paragraphs (1) and (2) of subdivision (a), the term “permanent disability” in relation to subsequent compensable injuries occurring on or after January 1, 2013, shall be measured by the whole person impairment rating, also referred to as the impairment standard, as determined in accordance with the AMA Guides to the Evaluation of Permanent
Impairment, 5th Edition, after multiplication by the adjustment factor referred to in subdivision (b) of Section 4660.1 and without regard to, or adjustment for, the occupation or age of the employee.
</html:p>
<html:p>
(d)
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Subdivisions (b) and (c) are declarative of existing law.
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<ns0:Num>SEC. 2.</ns0:Num>
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Section 4753.5 of the
<ns0:DocName>Labor Code</ns0:DocName>
is amended to read:
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<ns0:LawSection id="id_39834D06-2C12-484E-AEE5-769AF092F7ED">
<ns0:Num>4753.5.</ns0:Num>
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<ns0:Content>
<html:p>In any hearing, investigation, or proceeding, the state shall be represented by the Attorney General, or the attorneys of the Department of Industrial Relations, as appointed by the Director of Industrial Relations. Expenses incident to representation, including costs for investigation, medical examinations, other expert reports, fees for witnesses, and other necessary and proper expenses, but excluding the salary of any of the Attorney General’s deputies, shall be reimbursed from the Workers’ Compensation Administration Revolving Fund. No witness fees or fees for medical or medical-legal services shall exceed those fees for the same services prescribed by the appeals board or the administrative director by rule or regulation. Reimbursement pursuant to this section
shall be in addition to, and in augmentation of, any other appropriations made or funds available for the use or support of the legal representation.</html:p>
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<ns0:Num>SEC. 3.</ns0:Num>
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Section 4754 of the
<ns0:DocName>Labor Code</ns0:DocName>
is amended to read:
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<ns0:LawSection id="id_ECC874DF-C6AF-4779-8315-09A46B105FE8">
<ns0:Num>4754.</ns0:Num>
<ns0:LawSectionVersion id="id_3FDDE316-81AB-4AFD-87C5-370FE02E10AD">
<ns0:Content>
<html:p>The appeals board shall fix and award the amounts of special additional compensation to be paid under this article, and shall direct the Director of Industrial Relations, as trustee of the Subsequent Injuries Benefits Trust Fund, to pay the additional compensation so awarded.</html:p>
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<ns0:Num>SEC. 4.</ns0:Num>
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Section 4754.1 is added to the
<ns0:DocName>Labor Code</ns0:DocName>
, to read:
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<ns0:LawSection id="id_40E869B9-D292-434F-BBB1-F041CD3C8394">
<ns0:Num>4754.1.</ns0:Num>
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<html:p>
(a)
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This section shall apply to compensable subsequent injuries occurring on or after January 1, 2026.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
For purposes of determining eligibility for, and the amount of an award of, special additional compensation to be paid under this article, the existence of a prior permanent partial disability that existed at the time of the subsequent compensable injury shall be determined by substantial
evidence, based on medical records, testimony, or other evidence, that the prior permanent partial disability predated the subsequent compensable injury and that the prior permanent partial disability resulted in loss of earnings, interfered with work activities of the employee, or otherwise impacted the ability of the employee to perform work activities or activities of daily living.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
For purposes of determining the existence of a prior permanent partial disability that existed at the time of the subsequent compensable injury pursuant to subdivision (b), the following conditions shall not be considered as preexisting labor disabling disabilities for determining eligibility for benefits pursuant to this article:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
Acid reflux,
including gastroesophageal reflux disease.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Diabetes.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
Sleep apnea.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
Sexual dysfunction.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
Medical-legal evidence in a proceeding filed for compensation pursuant to this article may only be obtained in the manner set forth in Article 2 (commencing with Section 4060) of Chapter 7 of Part 1 of this Division.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
The administrative director shall create and maintain a database of qualified medical evaluator physicians who have the necessary training and expertise to perform evaluations for claims filed pursuant to Section 4751. This database shall be used by the medical director to fulfill requests for a panel of qualified medical evaluators filed pursuant to subdivision (d).
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
The Director of Industrial Relations shall have authority to issue regulations as necessary for the implementation and orderly and effective administration of this article.
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<ns0:Num>SEC. 5.</ns0:Num>
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Section 4754.2 is added to the
<ns0:DocName>Labor Code</ns0:DocName>
, to read:
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<ns0:Num>4754.2.</ns0:Num>
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<html:p>For all subsequent compensable injuries occurring on or after January 1, 2026, the limitations period within which an employee may file an application for special additional compensation pursuant to this article shall be five years from the date of the subsequent compensable injury, or one year from the date that the level of permanent disability arising from the subsequent compensable injury is determined by the appeals board, whichever occurs later.</html:p>
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<ns0:Num>SEC. 6.</ns0:Num>
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Section 4755 of the
<ns0:DocName>Labor Code</ns0:DocName>
is amended to read:
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<ns0:LawSection id="id_89586922-C33E-401D-BB68-10074CD82ACA">
<ns0:Num>4755.</ns0:Num>
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<html:p>
(a)
<html:span class="EnSpace"/>
The Director of Industrial Relations, as trustee of the Subsequent Injuries Benefits Trust Fund, may draw from the State Treasury out of the Subsequent Injuries Benefits Trust Fund for the purposes specified in Section 4751, without at the time presenting vouchers and itemized statements, a sum not to exceed in the aggregate fifty thousand dollars ($50,000), to be used as a cash revolving fund. The revolving fund shall be deposited in any banks and under any conditions as the Department of Finance determines. The Controller shall draw their warrants in favor of the Director of Industrial Relations, as trustee of the Subsequent Injuries Benefits Trust Fund, for the amounts so withdrawn and the Treasurer shall pay these
warrants.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
Expenditures made from the revolving fund in payments on claims for any additional compensation and for adjusting services are exempted from the operation of Section 16003 of the Government Code. Reimbursement of the revolving fund for these expenditures shall be made upon presentation to the Controller of an abstract or statement of the expenditures. The abstract or statement shall be in any form as the Controller requires.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
The director shall assign claims adjustment services and legal representation services respecting matters concerning subsequent injuries. The director or their representative may make these service assignments within the department, or they may contract for these services with the State Compensation Insurance Fund, for a fee in addition to
that authorized by Section 4754, except insofar as these matters might conflict with the interests of the State Compensation Insurance Fund. The administrative costs associated with these services shall be reimbursed from the Workers’ Compensation Administration Revolving Fund, except when a budget impasse requires advances as provided in subdivision (d) of Section 62.5. To the extent permitted by state law, the director may contract for audits or reports of services under this section.
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|
| Last Version Text 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 employment. Existing law provides certain methods for determining workers’ compensation benefits payable to a worker or the worker’s dependents for purposes of permanent total disability or permanent partial disability that include a determination of the percentage of permanent disability incurred. Existing law requires that, for injuries incurred before January 1, 2013, in determining the percentages of permanent disability, account be taken of the nature of the physical injury or disfigurement, the occupation of the injured employee, and the injured employee’s age at the time of the injury, and requires that specified factors be considered in determining an employee’s diminished earning capacity for these purposes. For purposes of these provisions, “nature of the physical injury or disfigurement” incorporates the descriptions and measurements of physical impairment and the corresponding percentages of impairments published in the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment (5th Edition). For injuries occurring on or after January 1, 2013, in determining the percentages of permanent disability, existing law requires the same factors be taken into account but removes from consideration the employee’s diminished future earning capacity and, instead, incorporates an adjustment factor of 1.4, as specified. Existing law also establishes the Subsequent Injuries Benefits Trust Fund, a continuously appropriated fund. Under existing law, if a permanently, partially disabled employee receives a subsequent compensable injury resulting in additional permanent disability, then that employee receives compensation from the Subsequent Injuries Benefits Trust Fund. Existing law requires, when applicable, the additional permanent disability resulting from the subsequent injury to be equal to 35% or more of total, when considered alone and without regard to, or adjustment for, the occupation or the age of the employee. For purposes of determining permanent disability resulting from a subsequent injury, this bill would measure permanent disability, for injuries occurring on or after January 1, 2005, and prior to January 1, 2013, by the whole person impairment rating as determined in accordance with the AMA Guides to the Evaluation of Permanent Impairment (5th Edition), after adjustment for diminished future earning capacity and without regard to, or adjustment for, the occupation or age of the employee. For injuries occurring on or after January 1, 2013, the bill would measure permanent disability in the same manner as an injury occurring on or after January 1, 2005, and prior to January 1, 2013, except that an adjustment for diminished future earning capacity is replaced by the 1.4 adjustment factor. The bill would state that these provisions are declarative of existing law. To the extent the bill changes the eligibility requirements for and calculation for payments made from the Subsequent Injuries Benefits Trust Fund, the bill would make an appropriation. This bill would, for compensable subsequent injuries occurring on or after January 1, 2026, require, for purposes of determining eligibility for and the amount of an award of special additional compensation, the existence of the prior permanent partial disability at the time of the subsequent compensable injury to be determined by substantial evidence, based on medical records, testimony, or other evidence, that the prior permanent partial disability predated the subsequent compensable injury and that the prior permanent partial disability resulted in loss of earnings, interfered with work activities, or otherwise impacted the ability of the employee to perform work activities or activities of daily living. For these compensable subsequent injuries occurring on or after January 1, 2026, the bill would require an employee to file an application for special additional compensation pursuant to these provisions within 5 years from the date of the subsequent compensable injury or one year from the date that the level of permanent disability arising from the subsequent compensable injury is determined by the Workers’ Compensation Appeals Board (WCAB), whichever occurs later. The bill would require the administrative director to create and maintain a database of qualified medical evaluators to perform evaluations for claims filed for a subsequent compensable injury. The bill would make conforming changes. Existing law requires the WCAB to fix and award the amounts of special additional compensation to be paid and to direct the State Compensation Insurance Fund (SCIF) to pay the additional compensation awarded. Existing law authorizes the additional compensation to be paid only from funds appropriated for these purposes. Existing law authorizes SCIF to reimburse itself for specified costs from this appropriation. This bill would replace SCIF with the Director of Industrial Relations, as trustee of the Subsequent Injuries Benefits Trust Fund, as the entity to pay the additional compensation awarded by the WCAB. The bill would delete SCIF’s authorization to reimburse itself for specified costs. |