2016 -- S 2945 SUBSTITUTE A

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2016

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A N   A C T

RELATING TO LABOR AND LABOR RELATIONS -- WORKERS' COMPENSATION

COURT

     

     Introduced By: Senators P Fogarty, McCaffrey, Ciccone, Lombardo, and Gee

     Date Introduced: May 05, 2016

     Referred To: Senate Labor

     It is enacted by the General Assembly as follows:

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     SECTION 1. Section 28-30-22 of the General Laws in Chapter 28-30 entitled "Workers'

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Compensation Court" is hereby amended to read as follows:

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     28-30-22. Medical advisory board. -- (a) The chief judge of the workers' compensation

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court, in consultation with the appropriate medical or professional association, shall appoint a

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medical advisory board that shall serve at the chief judge's pleasure and consist of eleven (11)

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members in the following specialties: one orthopedic surgeon; one neurologist; one physiatrist;

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one chiropractor; one physical therapist; one internist; one psychiatrist or psychologist; and four

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(4) ad hoc physician members appointed at the discretion of the chief judge. Members of the

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board shall be reimbursed three hundred dollars ($300) five hundred dollars ($500) per day

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served in the discharge of the board's duties, not to exceed six thousand dollars ($6,000) per

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member in any year. The chief judge shall designate the chairperson of the board.

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      (b) The chief judge is authorized, with the advice of the medical advisory board, to do

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the following:

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      (1) (i) Adopt and review protocols and standards of treatment for compensable injury,

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which shall address types, frequency, modality, duration, and termination of treatment, and types

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and frequency of diagnostic procedures.

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      (ii) Within thirty (30) days of its establishment, the medical advisory board shall prepare

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a recommended standard for the consideration and weighing by the court of medical evidence,

 

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including, but not limited to, medical test results, objective clinical findings, subjective

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complaints supported by tests for inconsistency, and purely subjective complaints, with the

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purposes of assuring treatment and compensation for legitimate compensable injuries; reducing

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litigation, inefficiency, and delay in court proceedings; and deterring false or exaggerated claims

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of injury. The standards shall be applicable to proceedings before the workers' compensation

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court, including specifically those to determine the nature and extent of injury and the

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achievement of maximum medical improvement, and shall be effective in all proceedings when

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adopted by the court.

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      (2) Approve and promulgate rules, regulations, and procedures concerning the

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appointment and qualifications of comprehensive, independent health care review teams that

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would be composed of any combination of one or more health care provider(s), rehabilitation

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expert(s), physical therapist(s), occupational therapist(s), psychologist(s), and vocational

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rehabilitation counselor(s).

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      (3) Approve and administer procedures to disqualify or disapprove medical service

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providers and maintain the approved provider list.

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      (4) Appoint an administrator of the medical advisory board.

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      (5) Approve and promulgate rules, regulations, and procedures concerning the

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appointment and qualifications of impartial medical examiners.

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      (6) Annually review the performance of each comprehensive, independent health care

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review team and impartial medical examiner.

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      (c) The administrator of the medical advisory board is authorized and directed to

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establish terms and conditions for comprehensive, independent health care review teams and

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impartial medical examiners to apply for approval by the medical advisory board and to perform

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any other duties as directed by the board.

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      (d) Any reference to an impartial medical examiner in chapters 29 -- 38 of this title shall

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be deemed to include the impartial medical examiners and comprehensive, independent health

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care review teams referred to in subsection (b) of this section.

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      (e) (1) Disqualification of medical care providers. - Every health care provider licensed

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in the state of Rhode Island shall be presumed to be qualified to provide health care services for

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injuries compensable under this title and may recover costs of treatment consistent with

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established fee and cost schedules. The administrator of the medical advisory board is thereafter

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authorized to disqualify and/or suspend any qualified provider based upon one or more of the

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following:

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      (i) The violation of the protocols and standards of care established by the medical

 

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advisory board;

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      (ii) The filing of affidavits that are untimely, inadequate, incomplete, or untruthful;

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      (iii) The provision of unnecessary and/or inappropriate treatment;

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      (iv) A pattern of violation and/or evasion of an approved fee schedule;

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      (v) The censure or discipline of the provider by the licensing body of the provider's

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profession;

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      (vi) The billing of, or pursuing collection efforts against, the employee for treatment or

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diagnostic tests causally related to an injury not deemed non-compensable by the workers'

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compensation court.

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      (2) Upon disqualification or during suspension, the provider shall not be permitted to

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recover any costs or fees for treatment provided under this title. The appropriate body with

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professional disciplinary authority over the provider shall be notified of any such action. Appeal

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of disqualification or suspension shall be to the medical advisory board, with final review by the

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workers' compensation court.

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      (3) If unnecessary or inappropriate treatment is provided by an entity affiliated with the

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treating physician, the administrator of the medical advisory board may increase the penalty for a

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violation.

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      (4) This section shall not prevent the recovery of reasonable costs for immediate

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emergency care rendered by a provider.

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      (f) As a guide to the interpretation and application of this section, the policy and intent of

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this legislature is declared to be that every person who suffers a compensable injury with

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resulting disability should be provided with high-quality medical care and the opportunity to

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return to gainful employment as soon as possible with minimal dependence on compensation

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awards.

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     SECTION 2. Sections 28-33-18.3, 28-33-39 and 28-33-41 of the General Laws in

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Chapter 28-33 entitled "Workers' Compensation - Benefits" are hereby amended to read as

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follows:

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     28-33-18.3. Continuation of benefits -- Partial incapacity. -- (a) (1) For all injuries

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occurring on or after September 1, 1990, in those cases where the employee has received a notice

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of intention to terminate partial incapacity benefits pursuant to § 28-33-18, the employee, or his

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or her duly authorized representative, may file with the workers' compensation court a petition for

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continuation of benefits on forms prescribed by the workers' compensation court. In any

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proceeding before the workers' compensation court on a petition for continuation of partial

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incapacity benefits, where the employee demonstrates by a fair preponderance of the evidence

 

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that his or her partial incapacity poses a material hindrance to obtaining employment suitable to

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his or her limitation, partial incapacity benefits shall continue. For injuries on and after July 1,

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2021 2023, "material hindrance" is defined to include only compensable injuries causing a greater

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than sixty-five percent (65%) degree of functional impairment and/or disability. Any period of

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time for which the employee has received benefits for total incapacity shall not be included in the

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calculation of the three hundred and twelve-week (312) period.

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      (2) The provisions of this subsection apply to all injuries from Sept. 1, 1990, to July 1,

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2021 2023.

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      (b) (1) Where any employee's incapacity is partial and has extended for more than three

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hundred and twelve (312) weeks and the employee has proved an entitlement to continued

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benefits under subsection (a) of this section, payments made to these incapacitated employees

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shall be increased annually on the tenth (10th) day of May thereafter so long as the employee

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remains incapacitated. The increase shall be by an amount equal to the total percentage increase

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in the annual Consumer Price Index, United States City Average for Urban Wage Earners and

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Clerical Workers, as formulated and computed by the Bureau of Labor Statistics of the United

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States Department of Labor for the period of March 1 to February 28 each year.

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      (2) "Index", as used in this section, refers to the Consumer Price Index, United States

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City Average for Urban Wage Earners and Clerical Workers, as that index was formulated and

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computed by the Bureau of Labor Statistics of the United States Department of Labor.

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      (3) The annual increase shall be based upon the percentage increase, if any, in the

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Consumer Price Index for the month of a given year, over the index for February, the previous

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year. Thereafter, increases shall be made on May 10 annually, based upon the percentage

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increase, if any, in the Consumer Price Index for the period of March 1 to February 28.

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      (4) The computations in this section shall be made by the director of labor and training

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and promulgated to insurers and employers making payments required by this section. Increases

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shall be paid by insurers and employers without further order of the court. If payment payable

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under this section is not mailed within fourteen (14) days after the employer or insurer has been

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notified by publication in a newspaper of general circulation in the state it becomes due, there

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shall be added to the unpaid payment an amount equal to twenty percent (20%) of it, to be paid at

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the same time as, but in addition to, the payment.

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      (5) This section applies only to payment of weekly indemnity benefits to employees as

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described in subdivision (1) of this subsection and does not apply to specific compensation

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payments for loss of use or disfigurement or payment of dependency benefits or any other

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benefits payable under the workers' compensation act.

 

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      (c) No petitions for commutation shall be allowed or entertained in those cases where an

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employee is receiving benefits pursuant to this section.

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     28-33-39. Transportation costs for medical examination. -- The reasonable costs of

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transportation to and from the office of any examiner requested by the employer or of any

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impartial examiner appointed as provided in § 28-33-35 shall be charged to the employer and, if

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paid for by the employee, he or she shall be reimbursed in full for this expenditure by his or her

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employer, upon presentation of a receipt or other evidence of expenditure. The reasonable cost of

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transportation that occurs on or after July 1, 2016, is the rate equal to the per-mile rate allowed by

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the Internal Revenue Service for use of a privately owned automobile for business miles driven,

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as from time to time amended, for a private motor vehicle or the reasonable cost incurred for

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transportation, from the employee's point of departure, whether from the employee's home or

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place of employment, and return.

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     28-33-41. Rehabilitation of injured persons. -- (a) (1) The department and the workers'

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compensation court shall expedite the rehabilitation of and the return to remunerative

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employment of all employees who are disabled and injured and who are subject to chapters 29 --

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38 of this title.

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      (2) Rehabilitation means the prompt provision of appropriate services necessary to

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restore an employee who is occupationally injured or diseased to his or her optimum physical,

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mental, vocational, and economic usefulness. This may require medical, vocational, and/or

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reemployment services to restore an employee who is occupationally disabled as nearly as

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possible to his or her pre-injury status. As a procedure, rehabilitation may include three (3)

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overlapping and interrelated components:

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      (i) (A) Medical restorative services. - Medical treatment and related services needed to

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restore the employee who is occupationally disabled to a state of health as near as possible to that

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which existed prior to the occupational injury or disease. These services may include, but are not

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limited to, the following: medical, surgical, hospital, nursing services, attendant care, chiropractic

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care, physical therapy, occupational therapy, medicines, prostheses, orthoses, other physical

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rehabilitation services, including psychosocial services, and reasonable travel expenses incurred

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in procuring the services.

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      (B) (I) Treatment by spiritual means. - Nothing in this chapter shall be construed to

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require an employee who in good faith relies on or is treated by prayer or spiritual means by a

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duly accredited practitioner of a well recognized church to undergo any medical or surgical

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treatment, and weekly compensation benefits may not be suspended or terminated on the grounds

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that the employee refuses to accept recommended medical or surgical benefits. The employee

 

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shall submit to all physical examinations as required by chapters 29 -- 38 of this title.

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      (II) However, a private employer, insurer, self-insurer or group self-insurer may pay or

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reimburse an employee for any costs associated with treatment by prayer or spiritual means.

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      (ii) Vocational restorative services. - Vocational services needed to return the employee

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with a disability to his or her pre-injury employment or, if that is not possible, to a state of

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employability in suitable alternative employment. These services may include, but are not limited

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to, the following: psychological and vocational evaluations, counseling, and training.

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      (iii) Reemployment services. - Services used to return the employee who is

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occupationally disabled to suitable, remunerative employment as adjudged by his or her

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functional and vocational ability at that time.

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      (b) (1) Any employer or any injured employee with total disability or permanent partial

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disability to whom the insurance carrier or certificated employer has paid compensation for a

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period of three (3) months or more, and to whom compensation is still being paid, or his or her

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employer or insurer may file a petition with the workers' compensation court requesting approval

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of a rehabilitation program or may mutually agree to a rehabilitation program. Determinations

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shall be rendered by the workers' compensation court in accordance with this section and as

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provided in chapters 29 -- 38 of this title and the rules of practice of the Rhode Island workers'

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compensation court.

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      (2) Action shall be taken as in the judgment of the workers' compensation court shall

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seem practicable and likely to speed the recovery and rehabilitation of injured workers. However,

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rehabilitative services shall be appropriate to the needs and capabilities of injured workers.

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      (c) Compensation payments shall not be diminished or terminated while the employee is

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participating in a rehabilitation program approved by the workers' compensation court or agreed

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to by the parties. Provided, that compensation payments shall be suspended while an injured

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employee willfully refuses to participate in a rehabilitation program approved by the workers'

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compensation court or agreed to by the parties. When the employee has completed an approved

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rehabilitation program, the rehabilitation provider shall recommend, in the instance of vocational

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rehabilitation, an earnings capacity, or in the instance of physical rehabilitation provided or

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prescribed by a physician, a degree of functional impairment, and the employee shall be referred

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to the court for an earnings capacity adjustment to benefits, unless the employee has returned to

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gainful employment.

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      (d) The employer shall bear the expense of rehabilitative services agreed to or ordered

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pursuant to this section. If those rehabilitative services require residence at or near or travel to a

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rehabilitative facility, the employer shall pay the employee's reasonable expense for board,

 

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lodging, and/or travel. The reasonable cost of transportation on or after July 1, 2016, is the rate

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equal to the per-mile rate allowed by the Internal Revenue Service for use of a privately owned

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automobile for business miles driven, as from time to time amended, for a private motor vehicle

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or the reasonable cost incurred for transportation, from the employee's point of departure, whether

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from the employee's home or place of employment, and return.

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      (e) Except for the provisions of this section, the provisions of § 28-33-8 shall remain in

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full force and effect.

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      (f) For the purposes of this section, the director shall promulgate rules and regulations

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pursuant to chapter 35 of title 42 for certifying rehabilitation providers, evaluators, and

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counselors, and the director shall maintain a registry of those persons so certified. No plan of

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rehabilitation requiring the services of a rehabilitation counselor shall be approved by the

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workers' compensation court or agreed to by the parties unless the counselor is certified by the

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director. Any requests for approval of a rehabilitation plan pending before the director prior to

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September 1, 2000, will remain at the department for determination. All requests after this date

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will be heard by the workers' compensation court.

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     SECTION 3. Section 28-53-7 of the General Laws in Chapter 28-53 entitled "Rhode

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Island Uninsured Employers Fund" is hereby amended to read as follows:

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     28-53-7. Payments to employees of uninsured employers. -- (a) Where it is determined

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that the employee was injured in the course of employment while working for an employer who

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fails to maintain a policy of workers' compensation insurance as required by § 28-36-1 et seq., the

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uninsured employers fund shall pay the benefits to which the injured employee would be entitled

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pursuant to chapters 29 to 38 of this title subject to the limitations set forth herein.

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      (b) The workers' compensation court shall hear all petitions for payment from the fund

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pursuant to § 28-30-1 et seq., provided, however, that the uninsured employers fund and the

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employer shall be named as parties to any petition seeking payment of benefits from the fund.

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      (c) Where an employee is deemed to be entitled to benefits from the uninsured

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employers fund, the fund shall pay benefits for disability and medical expenses as provided

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pursuant to chapters 29 to 38 of this title except that the employee shall not be entitled to receive

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benefits for loss of function and disfigurement pursuant to the provisions of § 28-33-19.

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      (d) The fund shall pay cost, counsel and witness fees, as provided in § 28-35-32, to any

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employee who successfully prosecutes any petitions for compensation; petitions for medical

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expenses; petitions to amend a pretrial order or memorandum of agreement; and all other

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employee petitions; and to employees who successfully defend, in whole or in part, proceedings

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seeking to reduce or terminate any and all workers' compensation benefits; provided, however,

 

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that the attorney's fees awarded to counsel who represent the employee in petitions for lump sum

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commutation filed pursuant to § 28-33-25, or in the settlement of disputed cases pursuant to § 28-

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33-25.1, shall be limited to the maximum amount paid to counsel who serve as court-appointed

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attorneys in workers' compensation proceedings as established by rule or order of the Rhode

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Island supreme court.

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      (e) In the event that the uninsured employer makes payment of any monies to the

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employee to compensate the employee for lost wages or medical expenses, the fund shall be

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entitled to a credit for all such monies received by or on behalf of the employee against any future

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benefits payable directly to the employee.

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      (f) This section shall apply to injuries that occur on or after January July 1, 2017.

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     SECTION 4. Chapter 42-16.1 of the General Laws entitled "Department of Labor and

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Training" is hereby amended by adding thereto the following section:

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     42-16.1-19. Cost of legal and audit fees. – The director is hereby authorized and may in

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their discretion recover the reasonable cost of legal services and audit fees for services provided

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by in-house attorneys and/or other personnel of the department of labor and training or outside

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auditors and incurred by the department in matters pertaining to fraud investigations and

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examinations. Nothing in this section shall limit the power of the director to retain legal counsel

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to recover the costs of such legal counsel and auditors pursuant to other provisions of the general

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laws.

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     SECTION 5. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO LABOR AND LABOR RELATIONS -- WORKERS' COMPENSATION

COURT

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     This act would increase the daily reimbursement for members of the medical advisory

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board from three hundred dollars ($300) to five hundred dollars ($500). It would postpone from

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the years 2021 to the year 2023 the partial incapacity benefits deadline. The act would also extend

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the commencement date of the payments to employees of uninsured employers statute from

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January 1, 2017, to July 1, 2017. It would also change the mileage rate that employees who attend

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medical examinations or rehabilitation are paid to the Internal Revenue Service allowable rate

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and how the distance for the visit is calculated. This act would also authorize the director of labor

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and training to recover the cost of legal services and fees incurred in fraud investigations and

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examinations.

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     This act would take effect upon passage.

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