SB 1160 Summary

• Requires employers to establish utilization review processes accredited by independent nonprofits by July 1, 2018, to certify compliance with timeliness, medical standards, and anti-incentive policies for treatment denials.

• Authorizes medical treatment without prior approval for the first 30 days after injury if rendered by network physicians or employer-selected providers, except for specific services like surgery, imaging, and high-cost equipment that require prospective review.

• Increases administrative penalties for claims administrators violating data reporting requirements from $5,000 to $10,000 per year and requires posting a list of violators on the Division of Workers' Compensation website.

• Automatically stays liens filed by physicians or providers facing criminal fraud charges related to workers' compensation, medical billing, or Medicare/Medi-Cal fraud until criminal proceedings conclude.

• Requires lien claimants filing after January 1, 2017 to submit declarations under penalty of perjury certifying they meet specific criteria, with failure to file resulting in automatic lien dismissal.