Connecticut Seal

General Assembly

 

Raised Bill No. 151

February Session, 2012

 

LCO No. 495

 

*00495_______LAB*

 

Referred to Committee on Labor and Public Employees

 

Introduced by:

 

(LAB)

 

AN ACT CONCERNING ADDITIONAL REQUIREMENTS FOR AN EMPLOYER'S NOTICE TO DISPUTE CERTAIN CARE DEEMED REASONABLE FOR AN EMPLOYEE UNDER THE WORKERS' COMPENSATION ACT.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. (NEW) (Effective October 1, 2012) (a) No employer or an employer's insurer shall discontinue, reduce or deny a course of treatment which a physician or surgeon deems reasonable or necessary unless the employer notifies the commissioner, physician or surgeon and the employee of the proposed discontinuance, reduction or denial of the course of medical care and the commissioner approves such discontinuance, reduction or denial of such care in writing. Such notice shall specify the reason maintained by the employer or the employer's insurer that the course of medical care deemed reasonable by the physician is not reasonable and be in substantially the following form:

IMPORTANT

STATE OF CONNECTICUT WORKERS' COMPENSATION COMMISSION

YOU ARE HEREBY NOTIFIED THAT THE EMPLOYER OR INSURER INTENDS TO DISCONTINUE, REDUCE OR DENY TREATMENT .... (date) FOR THE FOLLOWING REASONS:

If you object to the discontinuance, reduction, or denial of treatment as stated in this notice, YOU MUST REQUEST A HEARING NOT LATER THAN 15 DAYS after your receipt of this notice, or this notice will automatically be approved.

To request an Informal Hearing, call the Workers' Compensation Commission District Office in which your case is pending.

Be prepared to provide medical and other documentation to support your objection. For your protection, note the date when you received this notice.

(b) No discontinuance or reduction of an ongoing course of treatment shall be effective unless approved in writing by the commissioner upon a determination that the proposed care is not reasonable. The parties may request a hearing on any such proposed discontinuance, reduction or denial not later than fifteen days after receipt of such notice. Such notice of intention to discontinue, reduce or deny medical treatment shall be issued not later than five days after a notice of need for treatment is received by the employer, employer's insurer, employer's claim administrator or Second Injury Fund. The commissioner shall not approve such discontinuance, reduction or denial prior to expiration of the period for requesting a hearing or the completion of the hearing, whichever is later. Either party may request a formal hearing on the commissioner's decision to grant or deny the discontinuance, reduction or denial. The employer shall have the burden of proof that the medical care or treatment is unreasonable.

(c) The notice required in subsection (a) of this section shall include an opinion from a physician licensed to practice medicine in Connecticut that the course of treatment recommended by the attending physician is not reasonable or necessary and does not meet the standard of care that should be exercised by a physician practicing in the same specialty as the attending physician and the basis for such opinion. If the employer intends to rely on the opinion of a physician who performs an examination pursuant to section 31-294f of the general statutes, and such examination has not yet taken place, then the name of the physician, date, time and location of the examination, which shall be held not more than two weeks after the employee's receipt of the notice, shall be attached to the notice in lieu of an opinion that the treatment is not reasonable or necessary. The treatment recommended by the attending physician or surgeon may not be discontinued, reduced or denied until the results of the examination pursuant to section 31-294f of the general statutes is considered at an informal hearing.

(d) If the employer or employer's insurer seeks to discontinue, reduce or deny the course of medical care found reasonable by a physician based upon a dispute between physicians not as to the reasonableness of the course of care, but as to the better course of care, the patient shall be entitled to choose the course of care after informed consent.

This act shall take effect as follows and shall amend the following sections:

Section 1

October 1, 2012

New section

Statement of Purpose:

To prevent an employer or employer's insurer from discontinuing, reducing or denying employee's course of treatment under the Workers' Compensation Act unless the employer provides notice and an opinion from another physician that such treatment is not reasonable, necessary, does not meet the appropriate standard of care.

[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]