No. 32058 (Amendment): R612-2-9. Changes of Doctors and Hospitals

DAR File No.: 32058
Filed: 10/15/2008, 01:13
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

The proposed rule, in conjunction with a corresponding amendment to Rule R602-2, transfers from the Commission's Adjudication Division to its Industrial Accidents Division the responsibility to authorize the Uninsured Employers' Fund (UEF) to pay for medical evaluations of indigent injured workers. (DAR NOTE: The proposed amendment to Rule R602-2 is under DAR No. 32055 in this issue, November 1, 2008, of the Bulletin.)

Summary of the rule or change:

The amendment amends Subsection R612-2-9(F) to authorize the Industrial Accidents Division director to approve, in appropriate cases, payment for necessary medical examinations of indigent injured workers by the UEF. The amendment also renumbers the currently existing Subsection R612-2-9(F) as (G).

State statutory or constitutional authorization for this rule:

Sections 34A-2-101 et seq., 34A-3-101 et seq., and 34A-1-104

Anticipated cost or savings to:

the state budget:

The proposed amendment merely transfers authority to approve payments for certain medical examinations from the Adjudication Division to the Industrial Accidents Division. This change will not result in any costs or savings to the state budget, either in its capacity as an employer or with respect to administering the workers' compensation system.

local governments:

The proposed amendment merely transfers authority to approve payments for certain medical examinations from the Adjudication Division to the Industrial Accidents Division. This change will not result in any costs or savings to local governments.

small businesses and persons other than businesses:

The proposed amendment merely transfers authority to approve payments for certain medical examinations from the Adjudication Division to the Industrial Accidents Division. This change will not result in any costs or savings to small businesses.

Compliance costs for affected persons:

The proposed amendment merely transfers authority to approve payments for certain medical examinations from the Adjudication Division to the Industrial Accidents Division. This change will not result in any compliance costs for businesses, insurance carriers or injured workers.

Comments by the department head on the fiscal impact the rule may have on businesses:

This amendment is intended to rationalize the Labor Commission's internal lines of authority for approving payments from the UEF for certain types of medical examinations for indigent injured workers. It will not have any impact, fiscal or otherwise, on businesses. Sherrie Hayashi, Commissioner

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Labor Commission
Industrial Accidents
HEBER M WELLS BLDG
160 E 300 S
SALT LAKE CITY UT 84111-2316

Direct questions regarding this rule to:

Larry Bunkall at the above address, by phone at 801-530-6988, by FAX at 801-530-6844, or by Internet E-mail at [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

12/01/2008

This rule may become effective on:

12/08/2008

Authorized by:

Sherrie Hayashi, Commissioner

RULE TEXT

R612. Labor Commission, Industrial Accidents.

R612-2. Workers' Compensation Rules-Health Care Providers.

R612-2-9. Changes of Doctors and Hospitals.

A. It shall be the responsibility of the insurance carrier or self-insured employer to notify each claimant of the change of doctor rules. Those rules are as follows:

1. If a company doctor, designated facility or PPO is named, the employee must first treat with that designated provider. The insurance carrier or self-insured employer shall be responsible for payment for the initial visit, less any health insurance copays and subject to any health insurance reimbursement, if the employee was directed to and treated by the employer's or insurance carrier's designated provider, and liability for the claim is denied and if the treating physician provided treatment in good faith and provided the insurance carrier or self-insured employer a report necessary to make a determination of liability. Diagnostic studies beyond plain x-rays would need prior approval unless the claimed industrial injury or occupational illness required emergency diagnosis and treatment.

2. The employee may make one change of doctor without requesting the permission of the carrier, so long as the carrier is promptly notified of the change by the employee.

(a) Physician referrals for treatment or consultation shall not be considered a change of doctor.

(b) Changes from emergency room facilities to private physicians, unless the emergency room is named as the "company doctor", shall not be considered a change of doctor. However, once private physician care has begun, emergency room visits are prohibited except in cases of:

(i) Private physician referral, or

(ii) Threat to life.

3. Regardless of prior changes, a change of doctor shall be automatically approved if the treating physician fails or refuses to rate permanent partial impairment.

B. Any changes beyond those listed above made without the permission of the carrier/self-insurer may be at the employee's own expense if:

1. The employee has received notification of rules, or

2. A denial of request is made.

C. An injured employee who knowingly continues care after denial of liability by the carrier may be individually responsible for payment. It shall be the burden of the carrier to prove that the patient was aware of the denial.

D. It shall be the responsibility of the employee to make the proper filings with the division when changing locale and doctor. Those forms can be obtained from the division.

E. Except in special cases where simultaneous attendance by two or more medical care practitioners has been approved by the carrier/employer or the division, or specialized services are being provided the employee by another physician under the supervision and/or by the direct referral of the treating physician, the injured employee may be attended by only one practitioner and fees will not be paid to two practitioners for similar care during the same period of time.

F. The Director of the Division of Industrial Accidents may authorize an injured worker to be examined by another physician for the purpose of obtaining a further medical examination or evaluation pertaining to the medical issues involved, and to obtain a report addressing these medical issues in all cases where:

1. The treating physician has failed or refused to give an impairment rating, and/or

2. A substantial injustice may occur without such further evaluation.

[F.]G. The Commission has jurisdiction to decide liability for medical care allegedly related to an industrial accident.

 

KEY: workers' compensation, fees, medical practitioner

Date of Enactment or Last Substantive Amendment: [July 1, ]2008

Notice of Continuation: April 28, 2008

Authorizing, and Implemented or Interpreted Law: 34A-2-101 et seq.; 34A-3-101 et seq.; 34A-1-104