April 24, 2025 | Sacramento, CA — MedLegalNews.com — The California Assembly Insurance Committee advanced two bills this week that could significantly impact the administration of workers’ compensation claims: AB 1329, which reforms the Subsequent Injuries Benefits Trust Fund (SIBTF), and AB 1870, which modifies the Independent Bill Review (IBR) process for medical billing disputes.
AB 1329: Defining Disability and Shifting Responsibility
Authored by Assemblymember Liz Ortega (D-Hayward), AB 1329 aims to clarify eligibility for SIBTF benefits and establish more predictable processes for medical evaluations.
For injuries occurring on or after January 1, 2026, the bill outlines the type of evidence needed to prove a prior permanent partial disability. Workers will need to show, through medical records or testimony, that their preexisting disability caused a loss of earnings, interfered with work, or impacted daily living before their subsequent industrial injury.
In addition, the bill proposes that:
- Medical-legal evaluations for SIBTF cases must follow Qualified Medical Evaluator (QME) rules.
- A QME database will be created to match appropriate evaluators to SIBTF cases.
- Payment responsibility for SIBTF benefits will shift from the State Compensation Insurance Fund to the Director of Industrial Relations.
- It clarifies how permanent disability ratings are determined using AMA Guides for injuries after 2005.
Supporters, including labor groups and applicant attorneys, say these changes will ensure that truly disabled workers receive additional compensation. However, some defense-side stakeholders have raised concerns about the administrative burden and cost-shifting.
AB 1870: Tightening the Independent Bill Review Process
Meanwhile, AB 1870, introduced by Assemblymember Matt Haney (D-San Francisco), seeks to eliminate the ability of providers to request Independent Bill Review before payment is issued or formally disputed by the claims administrator.
Under the proposed changes, IBR requests would only be allowed after:
- The claims administrator has issued a timely denial or adjustment, and
- The provider has completed the second review process, as currently required.
Proponents argue that the bill will reduce unnecessary IBR filings, cut administrative costs, and streamline billing disputes. Opponents, including medical provider groups, warn that it may delay fair resolution and limit access to review for underpaid claims.
What’s Next?
Both bills passed the Assembly Insurance Committee with majority support and now move to the Assembly Appropriations Committee for further fiscal analysis.
As the legislative session progresses, stakeholders on both sides of the workers’ compensation spectrum will continue to watch these bills closely. Their outcomes could reshape how California manages complex cases involving preexisting conditions and provider payment disputes.
Visit the California Legislative Information for updates on AB 1329 and AB 1870.
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FAQs: About SIBTF Reform and Workers’ Compensation Bills
What is SIBTF Reform and Why is it Important?
SIBTF reform is critical for addressing the rising costs and inefficiencies within the Subsequent Injuries Benefits Trust Fund. AB 1329 aims to clarify disability eligibility and streamline medical evaluations, ensuring that only eligible workers receive benefits.
How Does AB 1329 Affect Workers and Employers?
AB 1329 introduces clear guidelines for proving prior disabilities, making it easier for workers to qualify for SIBTF benefits. It also shifts responsibility for administering these claims, potentially improving efficiency but raising concerns among some employers about additional costs.
What is the Independent Bill Review (IBR) Process in Workers’ Compensation?
The IBR process allows medical providers to dispute underpayments for services rendered. AB 1870 seeks to restrict the timing of IBR requests, requiring disputes to be filed only after claims administrators issue a formal denial or adjustment, aiming to reduce unnecessary filings and administrative costs.
What’s Next for AB 1329 and AB 1870?
Both AB 1329 and AB 1870 have passed the Assembly Insurance Committee and are moving to the Assembly Appropriations Committee. These bills could significantly change how California handles workers’ compensation cases involving pre-existing conditions and billing disputes.