AN ACT CONCERNING TIMELY MEDICAL TREATMENT FOR INJURED WORKERS.

This bill makes a number of changes in workers' compensation law regarding medical treatment for injured workers.

First, it creates a presumption that an employer's or insurer's failure to promptly provide treatment recommended by a medical provider is an unreasonable delay without good cause unless a workers' compensation commissioner finds the recommended medical care was neither reasonable nor necessary when it was recommended. The commissioner can assess a penalty of up to $ 1,000 for each case of delay.

Second, the bill places specific requirements on employers who choose to object to a claimant's recommended medical treatment because they believe it is unreasonable or unnecessary. This includes, in cases involving an independent medical examination (IME), scheduling the IME to occur within 30 days after receiving the proposed treatment recommendation. The bill establishes employer penalties if the IME concurs with the original recommended treatment.

Third, it gives an employee the right to record his or her IME with either audio or video devices.

Lastly, it gives a workers' compensation commissioner the power to (1) fully review a decision to provide or deny medical care and (2) determine whether such care is reasonable or necessary.

The bill creates a presumption that an employer's or insurer's failure to promptly provide treatment recommended by a medical provider is an unreasonable delay without good cause unless a workers' compensation commissioner finds the recommended medical care was neither reasonable nor necessary when it was recommended. The commissioner can assess a penalty of up to $ 1,000 for each case of delay.

For the bill's purposes, recommended treatment that the employer or insurer is (1) unreasonably delaying or (2) objecting to as unreasonable or unnecessary is medical treatment recommended by a:

1. provider participating in an employer's medical plan, which was approved by a compensation commissioner;

2. physician in an approved voluntary agreement, as defined in workers' compensation law; or

3. medical provider the employee was referred to by a provider described in (1) or (2).

The bill requires employers who have good cause to object to a claimant's recommended medical treatment because it is unreasonable or unnecessary (1) to issue a written notice to the employee containing the medical evidence upon which the objection is based and (2) if they are seeking an independent medical examination (IME) to support their view, to schedule it to occur no later than 30 days after receiving the proposed treatment recommendation. If the employer fails to schedule the IME to occur within 30 days, the employee is entitled to recover any reasonable attorney's fees arising out of his or her successful claim for the treatment.

The bill also requires the employee to attend the scheduled IME or provide written notice that the employee needs the employer to reschedule it within an additional 30-day period.

If the employer's IME concurs with the original treatment recommendation, the employer must pay the claimant wage replacement benefits at a rate of 100% of the employee's net wages for the period the treatment was delayed due to the IME request, rather than the regular rate of 75% of net wages. The 100% calculation applies whether the employee qualifies for total or partial incapacity benefits.

By law, an injured employee is allowed to have his own physician accompany him or her to the IME, whether it is requested by the employer or ordered by a commissioner. The bill also allows the employee to record the IME by either an audio or video means.

By law, employers and insurers can sponsor medical plans, which must be approved by a commissioner, to provide the necessary care for injured workers under the Workers' Compensation Act. Under current regulation, a decision by the plan's chief executive officer to deny payment for medical or health care services is subject to review only if it is shown to be unreasonable, arbitrary, or capricious (CT. Agencies Reg. § 31-279-10(f)). The bill gives a commissioner the power to review a decision to provide or deny medical care under such a plan without having to show it meets the threshold stated in regulation. The bill allows the commissioner to decide whether the medical care is reasonable or necessary.

But it is unclear if the bill applies just to a medical plan's chief executive officer's decision or if it could be triggered by a decision at an earlier stage in the medical plan process.

By law, if a commissioner finds an insurer or employer caused an undue delay of wage loss payments through its own fault or neglect, the commissioner can order them to pay interest penalties and reasonable attorney's fees. The bill also allows the commissioner to make such a ruling for undue delays of medical treatment.

Yea

Nay

(03/10/2009)