Scope of Workers’ Compensation and Insurance

Labor Code Division 4, Part1 deals with the scope and operation of the workers’ compensation and insurance laws in this state. Chapter 1 contains general provisions.

Section 3200 contains a statement of legislative intent, as well as a statement of policy.

Section 3201 explains that specified provisions are an expression of the police power and are intended to make effective and apply to a complete system of workers’ compensation.

Section 3201.5 provides that the Department of Industrial Relations and the courts of this state are required to recognize as valid and binding any provision in a collective bargaining agreement between a private employer or groups of employers engaged in construction, construction maintenance, or activities limited to rock, sand, gravel, cement and asphalt operations, heavy-duty mechanics, surveying, and construction inspection and a union that is the recognized or certified exclusive bargaining representative that establishes any of the six specified circumstances.

Nothing in this section allows a collective bargaining agreement that diminishes the entitlement of an employee to compensation payments for total or partial disability, temporary disability, vocational rehabilitation, or medical treatment fully paid by the employer as otherwise provided in this division. The portion of any agreement that violates this paragraph is null and void.

The parties may negotiate any aspect of the delivery of medical benefits and the delivery of disability compensation to employees of the employer or group of employers that are eligible for group health benefits and nonoccupational disability benefits through their employer. This provision only applies in four specified circumstances.

Section 3201.7 requires the Department of Industrial Relations and the courts of this state to recognize as valid and binding any labor-management agreement that meets all of the three specified requirements. Nothing in this section allows a labor-management agreement that diminishes the entitlement of an employee to compensation payments for total or partial disability, temporary disability, vocational rehabilitation, or medical treatment fully paid by the employer as otherwise provided in this division. The portion of any agreement that violates this paragraph is null and void. This applies to four specified entities.

Section 3201.81 provides that, in the horse racing industry, the organization certified by the California Horse Racing Board to represent the majority of licensed jockeys is the labor organization authorized to negotiate the collective bargaining agreement establishing an alternative dispute resolution system for licensed jockeys.

Section 3201.9 explains that the required biannual report must include updated loss experience for all employers and groups of employers participating in a program established under those sections. The report also must include updated data on specified items. Updates for each program must be done for the original program year and for subsequent years. The insurers, the Department of Insurance, and the rating organization designated are required to provide the administrative director with any information that the administrative director determines is reasonably necessary to conduct the study.

Section 3202 requires this division to be liberally construed by the courts with the purpose of extending their benefits for the protection of persons injured in the course of their employment.

Section 3202.5 requires all parties and lien claimants to meet the evidentiary burden of proof on all issues by a preponderance of the evidence in order that all parties are considered equal before the law. The term “preponderance of the evidence” is defined.

Section 3203 provides that specified provisions do not apply to employers or employments which, according to law, are so engaged in interstate commerce as not to be subject to the legislative power of the state, nor to employees injured while they are so engaged.

Section 3204 provides that the definitions set forth in this chapter govern the construction and meaning of the terms and phrases used in this division.

Section 3205 defines the term “division.”

Section 3205.5 defines the term “appeals board.”

Section 3206 defines the term “Administrative director.”

Section 3206.5 says that, for the purpose of this division and subject to restrictions or requirements that may be adopted by the administrative director or the Workers’ Compensation Appeals Board, documents that require a signature, including the signature of a notary on an acknowledgment, may be filed with an “electronic signature.”

Section 3207 defines the term “compensation.”

Section 3208 defines the term “injury.”

Section 3208.5 additionally defines the term “injury.” The term “health care worker” is defined.

Section 3208.1 defines the terms “specific” and “cumulative.”

Section 3208.2 provides that, when disability, need for medical treatment, or death results from the combined effects of two or more injuries, either specific, cumulative, or both, all questions of fact and law are to be separately determined with respect to each injury, including the apportionment between injuries of liability for disability benefits, the cost of medical treatment, and any death benefit.

Section 3208.3 makes a psychiatric injury compensable if it is a mental disorder which causes disability or need for medical treatment, and it is diagnosed pursuant to procedures promulgated. In order to establish that a psychiatric injury is compensable, an employee is required to demonstrate by a preponderance of the evidence that actual events of employment were predominant as to all causes combined of the psychiatric injury. The term “substantial cause” is defined. There is a statement of legislative intent.

Section 3208.4 provides that, in any proceeding under this division involving an injury arising out of alleged conduct that constitutes sexual harassment, sexual assault, or sexual battery, any party seeking discovery concerning sexual conduct of the applicant with any person other than the defendant, must establish specific facts showing good cause for that discovery on a noticed motion to the appeals board. The motion cannot be made or considered at an ex parte hearing.

Section 3209 defines the term “damages.”

Section 3209.3 defines the terms “physician,” “psychologist,” and “acupuncturist.”

Section 3209.4 states that the inclusion of optometrists does not imply any right or entitle any optometrist to represent, advertise, or hold himself out as a physician.

Section 2309.5 provides that medical, surgical, and hospital treatment includes services and supplies by physical therapists, licensed clinical social workers, chiropractic practitioners, and acupuncturists.

Section 3209.6 explains that the inclusion of chiropractors does not imply any right or entitle any chiropractor to represent, advertise, or hold himself out as a physician.

Section 3209.7 provides that treatment of injuries at the expense of the employer may also include any other form of therapy, treatment, or healing practice agreed upon voluntarily in writing, between the employee and his employer.

Section 3209.8 states that treatment reasonably required to cure or relieve from the effects of an injury must include the services of marriage and family therapists, professional clinical counselors, and clinical social workers licensed by California state law and within the scope of their practice as defined by state law if the injured person is referred to the marriage and family therapist, the professional clinical counselor, or the clinical social worker by a licensed physician and surgeon, with the approval of the employer, for treatment of a condition arising out of the injury.

This section does not authorize marriage and family therapists, professional clinical counselors, or clinical social workers to determine disability. The requirement of this section that the employer approve the referral by a licensed physician or surgeon cannot be construed to preclude reimbursement for self-procured treatment, found by the appeals board to be otherwise compensable pursuant to this division, if the employer has refused to authorize any treatment for the condition arising from the injury treated by the marriage and family therapist, professional clinical counselor, or clinical social worker.

Section 3209.9 says that the inclusion of acupuncturists does not imply any right or entitle any acupuncturist to represent, advertise, or hold himself or herself out as a physician or surgeon holding an M.D. or D.O. degree.

Section 3209.10 explains that medical treatment of a work-related injury required to cure or relieve the effects of the injury may be provided by a state licensed physician assistant or nurse practitioner, acting under the review or supervision of a physician and surgeon pursuant to standardized procedures or protocols within their lawfully authorized scope of practice. The term “medical treatment” is defined.

Section 3209.11 provides that an employer, workers’ compensation insurer, self-insured employer, or agent of an employer, insurer, or self-insured employer may provide an employee with access to the services of a licensed clinical social worker acting within their scope of practice. Medical provider networks may add licensed clinical social workers to the physician providers listing in the networks established or modified. The term “licensed clinical social worker” is defined.

Section 3210 defines the term “person.”

Section 3211 defines the term “insurer.”

Section 3211.5 defines the terms “firefighter,” “firefighting member,” and “member of a fire department.”

Section 3211.9 defines the term “disaster council.”

Section 3211.91 defines the term “accredited disaster council.”

Section 3211.92 defines the terms “disaster service worker” and “disaster service worker.”

Section 3211.93 defines the term “disaster service.”

Section 32111.93a defines what is not “disaster service.”

Section 3212 says that, in the case of members of a sheriff’s office or the California Highway Patrol, district attorney’s staff of inspectors and investigators or of police or fire departments, and in the case of active firefighting members whether voluntary, fully paid, or partly paid, the term “injury” is defined.

Section 3212.1 applies to six specified categories of workers. The term “injury” is defined.

Section 3212.2 provides for an officer and employee in the Department of Corrections and Rehabilitation having custodial duties and for a peace officer employed by the State Department of State Hospitals. The term “injury” is defined.

Section 3212.3 states that, in the case of a peace officer who is designated by law and who has graduated from an academy certified by the Commission on Peace Officer Standards and Training, when that officer is employed upon a regular, full-time salary. The term “injury” is defined.

Section 3212.4 says that, in the case of a member of a University of California fire department located at a campus or other facility administered by the Regents of University of California, when any member is employed by a department upon a regular, full-time salary, on a nonprobationary basis, the term “injury” is defined.

Section 3212.5 states that, in the case of a member of a police department of a city or municipality, or a member of the State Highway Patrol, when any member is employed upon a regular, full-time salary, and in the case of a sheriff or deputy sheriff, or an inspector or investigator in a district attorney’s office of any county, employed upon a regular, full-time salary, the term “injury” is defined.

Section 3212.7 states that, in the case of an employee in the Department of Justice falling within the “state safety” class, when any such individual is employed under civil service upon a regular, full-time salary, the term “injury” is defined.

Section 3212.8 provides that, in the case of members of a sheriff’s office, of police or fire departments of cities, counties, cities and counties, districts, or other public or municipal corporations or political subdivisions, or individuals, whether those persons are volunteer, partly paid, or fully paid, and in the case of active firefighting members of the Department of Forestry and Fire Protection, or of any county forestry or firefighting department or unit, whether voluntary, fully paid, or partly paid, excepting those whose principal duties are clerical or otherwise do not clearly fall within the scope of active law enforcement service or active firefighting services, such as stenographers, telephone operators, and other officeworkers, the term “injury” is defined.

Section 3212.9 states that, in the case of law enforcement officials and fire department members, excepting those whose principal duties are clerical or otherwise do not clearly fall within the scope of active law enforcement or firefighting, such as stenographers, telephone operators, and other officeworkers, the term “injury” is defined.

Section 3212.10 states that, in the case of a peace officer of the Department of Corrections who has custodial or supervisory duties of inmates or parolees, or a peace officer of the Department of the Youth Authority who has custodial or supervisory duties of wards or parolees, the term “injury” is defined.

Section 3212.11 applies to active lifeguards employed by a city, county, city and county, district, or other public or municipal corporation or political subdivision, and active state lifeguards employed by the Department of Parks and Recreation. The term “injury” is defined.

Section 3212.12 applies to peace officers, corpsmembers, and other employees at the California Conservation Corps classified as specified. The term “injury” is defined. The compensation that is awarded for Lyme disease shall include full hospital, surgical, medical treatment, disability indemnity, and death benefits, as provided by this division.

Section 3213 states that, in the case of a member of the University of California Police Department who has graduated from an academy certified by the Commission on Peace Officer Standards and Training, the term “injury” is defined.

Section 3213.2 provides that, in the case of a member of a police department of a city, county, or city and county, or a member of the sheriff’s office of a county, or a peace officer employed by the Department of the California Highway Patrol, or a peace officer employed by the University of California, the term “injury” is defined.

Section 3214 requires the Department of Corrections and the Department of the Youth Authority to develop policy and implement the workers’ compensation early intervention program for all department employees who sustain an injury.

Section 3215 states that any person acting individually or through his or her employees or agents, who offers, delivers, receives, or accepts any rebate, refund, commission, preference, patronage, dividend, discount or other consideration, whether in the form of money or otherwise, as compensation or inducement for referring clients or patients to perform or obtain services or benefits pursuant to this division, is guilty of a crime.

Section 3217 states that Section 3215 is not to be construed to prevent the recommendation of professional employment where that recommendation is not prohibited by the Rules of Professional Conduct of the State Bar.

Section 3218 notes that a violation of Section 3215 is a public offense punishable upon a first conviction by incarceration in the county jail for not more than one year, or by incarceration in the state prison, or by a fine not exceeding $10,000. A second or subsequent conviction is punishable by incarceration in state prison.

Section 3219 provides that any person acting individually or through his or her employees or agents, who offers or delivers any rebate, refund, commission, preference, patronage, dividend, discount, or other consideration to any adjuster of claims for compensation, as compensation, inducement, or reward for the referral or settlement of any claim, is guilty of a felony.

In addition, any adjuster of claims for compensation who accepts or receives any rebate, refund, commission, preference, patronage, dividend, discount, or other consideration, as compensation, inducement, or reward for the referral or settlement of any claim, is guilty of a felony.