No. 38805 (Amendment): Section R612-100-2. Definitions

(Amendment)

DAR File No.: 38805
Filed: 08/22/2014 08:40:58 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of the proposed amendments to Section R612-100-2 is to update and clarify those definitions that remain in use in the workers' compensation program, eliminate redundant or unnecessary definitions, and define additional terms that are in use but have not previously been defined.

Summary of the rule or change:

The amendment eliminates definitions of the following terms because they are defined elsewhere in statute or rule, are no longer in use, or do not require definition: "aggregate excess insurance"; "contact"; "department"; "emergency medical services provider"; "emergency medical services (EMS) agency"; "employee leasing company"; "global fee case"; "medical panel"; "medical practitioner"; "receiving facility"; "reserve"; "significant exposure"; "source patient"; and "specific excess insurance". Definitions are added for the following terms: "benefit"; "claimant"; "injury"; and "payor". The definition of "first aid", also added to the rule, is the same definition of the term that was previously found in Section R612-100-3, and also in Subsection R612-200-1(A). Other definitions were clarified to correspond with their usage throughout the Industrial Accidents Division's rules.

State statutory or constitutional authorization for this rule:

• Section 34A-1-104 et seq.
• Section 34A-2-101 et seq.
• Section 34A-3-101 et seq.
• Section 63G-4-102 et seq.

Anticipated cost or savings to:

the state budget:

Updating and clarifying Section R612-100-2's definitions will not have any substantive effect on the workers' compensation system. Consequently, the proposed amendment will not result in additional administrative or enforcement costs to the Labor Commission, nor will the changes affect the state's workers' compensation coverage expenses as an employer.

local governments:

Updating and clarifying Section R612-100-2's definitions will not have any substantive effect on the workers' compensation system. Consequently, the proposed amendment will not change local governments' workers' compensation coverage expenses as employers.

small businesses:

Updating and clarifying Section R612-100-2's definitions will not have any substantive effect on the workers' compensation system. Consequently, the proposed amendment will not change small businesses' workers' compensation coverage expenses as employers.

persons other than small businesses, businesses, or local governmental entities:

The proposed change to Section R612-100-2 is consistent with current practice and will not result in any additional expense to other persons.

Compliance costs for affected persons:

The elimination of unnecessary and redundant definitions, the addition of necessary definitions, and the clarification of other definitions will assist stakeholders in understanding and using the workers' compensation system. The proposed amendment is not expected to result in any additional compliance costs for affected persons.

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

The proposed changes to Section R612-100-2 are part of the Industrial Accidents Division's comprehensive review of all its workers' compensation rules. As already noted, the proposed amendment is not substantive in nature, but works to simplify, update, and clarify definitions used throughout the Division's rules. As such, the amendment will not increase stakeholder costs, but should make use of the Division's rules easier.

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:

• Ron Dressler at the above address, by phone at 801-530-6841, by FAX at 801-530-6804, 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:

10/15/2014

This rule may become effective on:

10/22/2014

Authorized by:

Sherrie Hayashi, Commissioner

RULE TEXT

R612. Labor Commission, Industrial Accidents.

R612-100. Workers' Compensation Rules - General Provisions.

R612-100-2. Definitions.

A. "Administrative Law Judge" or "ALJ" means a person [duly ]designated by the Commission to hear and decide disputed cases.

[B. "Aggregate Excess Insurance" is the amount of insurance required to cover the total accumulated workers' compensation benefits for all claims payable for a given period of time with the employer retaining an obligation for a designated amount as a deductible and the insurance company paying all amounts due thereafter up to a maximum total obligation.

][C]B. "[Applicant/Plaintiff]Claimant" means[, for purposes of a workers' compensation proceeding,] an injured employee, [or his/her ]dependent(s) of an injured employee, medical providers, or any other person seeking relief or claiming benefits under the Utah Workers' Compensation Act [and/]or Utah Occupational Disease Act[and Disability Laws].

[D]C. "Award" means [the finding or decision]a determination of the Commission, Appeals Board or Administrative Law Judge [as]of the benefits due a[n injured employee or the dependent(s) of a deceased employee]claimant.

D. "Benefits" includes any payment, entitlement, or other relief provided under the Utah Workers' Compensation Act or Utah Occupational Disease Act.

E. "Commission" means the Utah Labor Commission.

[F. "Contact" means the designated person(s) within an emergency medical services agency or the employer of an emergency medical services provider.

] [G]F. "Defendant" means[, for purposes of workers' compensation proceedings,] an employer, insurance carrier, [self-insurer, the ]Employers' Reinsurance Fund, [and/or the ]Uninsured Employers' Fund or other person or entity against whom a claim for benefits is made.

[H. "Department" means the Utah Labor Commission.

][I]G. "Division" means the Division of Industrial Accidents within the [Labor ]Commission.

[J]H. "Disabled Injured Worker" means an injured worker who:

1. because of the injury or disease that is the basis for the employee being an injured worker:

a. is or will be unable to return to work in the injured worker's usual and customary occupation; or

b. is unable to perform work for which the injured worker has previous training and experience; and

2. reasonably can be expected to attain gainful employment after an evaluation provided for in accordance with [the Utah Injured Worker Reemployment Act, Title 34A, Chapter 8a]Section 34A-2-413.5.

[K. "Emergency medical services provider" means Emergency Medical personnel as defined in Section 26-8a- 102, a public safety officer, local fire department personnel, or personnel employed by the Department of Corrections or by a county jail, who provide prehospital Emergency medical care for an emergency medical services agency either as an employee or a volunteer.

L. "Emergency medical services (EMS) agency" means an agency, entity, or organization that employs or utilizes emergency medical services providers as defined in (4) as employees or volunteers.

M. "Employee leasing company" is as defined per Title 58, Chapter 59.

][N]I. "Employer" is defined in Section 34A-2-103 of the Utah Workers Compensation Act and includes self-insured employers and uninsured employers[that are paying an injured workers' claim for benefits].

J. "First Aid" is medical care that is:

1. administered on-site or at an employer-sponsored free clinic; and

2. limited to the following:

a. non-prescription medications at non-prescription strength:

b. tetanus immunizations;

c. cleaning and applying bandages to skin surface wounds;

d. hot or cold packs, contrast baths and paraffin;

e. non-rigid support, such as elastic bandages, wraps, and back belts;

f. temporary immobilization devices for transporting an accident victim, such as splints, slings, neck collars, or back boards;

g. drilling a fingernail or toenail to relieve pressure, or draining fluids from blisters;

h. eye patches or use of simple irrigation or a cotton swab to remove foreign bodies not embedded in or adhering to an eye;

i. use of irrigation, tweezers, or cotton swab to remove splinters or foreign material;

j. finger guards;

k. massages;

l. drinking fluids to relieve heat stress.

3. "First aid" is limited to initial treatment and one follow-up visit within a seven-day period after the initial treatment, except that if first aid treatment was provided by a licensed health professional in an employer-sponsored free clinic, first aid includes initial treatment and two follow-up visits within a fourteen-day period after the initial treatment.

4. "First aid" does not include any treatment of a work injury that results in:

a. loss of consciousness;

b. loss of work;

c. restriction of work;

d. transfer to another job.

[O. "Global Fee Cases" - are those flat fee cases where fees include pre-operative and follow-up or aftercare.

]K. "Injury" includes work-related accidental injury and occupational disease.

[P]L. "[Insurer]Insurance Carrier" includes any worker's[workers'] compensation insurance carriers, [and ]self-insured employer[s] and self-insured employer's adjusting company, unless otherwise specified.

[Q. "Insurance Carrier" includes all insurance companies writing workers' compensation and occupational disease and disability insurance, the Workers' Compensation Fund, and self-insurers who are granted self- insuring privileges by the Commission. In all cases involving no insurance coverage by the employer, the term "Insurance Carrier" includes the employer.

R. "Medical Panel" means a panel appointed by an Administrative Law Judge pursuant to the standards set forth in Section 34A-2-601, which is responsible to make findings regarding disputed medical aspects of a compensation claim, and may make any additional findings, perform any tests, or make any inquiry as the Administrative Law Judge may require.

S. "Medical Practitioner" means any person trained in the healing arts and licensed by the State in which such person practices.

]M. "Payor" means any insurance carrier, self-insured employer, or uninsured employer that is liable for any benefit or other relief under the Utah Workers' Compensation Act or Utah Occupational Disease Act.

[T. "Receiving facility" means a hospital, health care or other facility where the patient is delivered by the emergency medical services provider for care.

U. "Reserve" is defined as the amount necessary to satisfy all debts, past, present, and future, incurred by reason of industrial accidents or occupational diseases, the origins of which commenced prior to the date of reserve determination.

V. "Significant Exposure" and "Significantly Exposed" mean exposure of the body of one person to the blood or body fluids visibly contaminated by blood of another person by:

1. percutaneous injury, including a needle stick or cut with a sharp object or instrument; or

2. contact with an open wound, mucous membrane, or non-intact skin because of a cut, abrasion, dermatitis, or other damage; or

W. "Source Patient" means any individual cared for by a pre-hospital emergency medical services provider, including but not limited to victims of accidents or injury, deceased persons, and prisoners or persons in the custody of the Department of Corrections.

X. "Specific Excess Insurance" is defined as the amount of insurance required to cover the workers' compensation benefits arising out of a specific occurrence (accident) or occupational disease under the Workers' Compensation Law with the employer retaining an obligation for a designated amount as a deductible and the insurance company assuming the obligation for all amounts due thereafter up to a maximum total obligation.

][Y]N. "Usual and Customary Rate (UCR)" is the rate of payment using Ingenix, or a similar service, for charges for services [for]in a particular zip code.

 

KEY: workers' compensation, administrative procedures

Date of Enactment or Last Substantive Amendment: [February 25, 2013]2014

Authorizing, and Implemented or Interpreted Law: 34A-2-101 et seq.; 34A-3-101 et seq.; 34A-1-104 et seq.; 63G-4-102 et seq.

 

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